=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477187045
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REMEDY CLINIC PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/23/2020
-----------------------------------------------------
Last Update Date | 04/15/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 702 10TH AVE
-----------------------------------------------------
City | LONGMONT
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80501-4536
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-641-6002
-----------------------------------------------------
Fax | 303-678-8533
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2229 SANTA FE DR
-----------------------------------------------------
City | LONGMONT
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80504-2312
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-641-6002
-----------------------------------------------------
Fax | 303-678-8533
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | CHRISTINE M. STONE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 303-641-6002
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------