Healthcare Provider Details

I. General information

NPI: 1881473569
Provider Name (Legal Business Name): ALLMO COLLECTIVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2023
Last Update Date: 05/13/2024
Certification Date: 05/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 GENEVA AVE STE 100
JOPLIN MO
64801-1645
US

IV. Provider business mailing address

301 N PAGOSA BLVD UNIT B10
PAGOSA SPRINGS CO
81147-7012
US

V. Phone/Fax

Practice location:
  • Phone: 970-946-8757
  • Fax: 970-264-5919
Mailing address:
  • Phone: 970-946-8757
  • Fax: 970-264-5919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: REILLY L ALLMOSLECHER
Title or Position: OWNER
Credential: NP
Phone: 970-946-8757