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General NPI Number Information
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NPI Number | 1205150521
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Entity Type | Organization
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Legal Business Name | FORT MORGAN PEDIATRIC CLINIC
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Dates
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Enumeration Date | 03/15/2010
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Last Update Date | 03/15/2010
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Provider Practice Location Address
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Address Line | 1000 LINCOLN ST SUITE 202
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City | FORT MORGAN
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State | CO
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Zip | 80701-3290
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Country | US
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Telephone | 970-542-2229
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 LINCOLN ST SUITE 202
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City | FORT MORGAN
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State | CO
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Zip | 80701-3290
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KEHINDE OBETO
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Credential |
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Telephone | 970-542-2229
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State | CO
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