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General NPI Number Information
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NPI Number | 1790162451
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Entity Type | Organization
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Legal Business Name | ADOLESCENT HEALTHCARE ASSOCIATES OF COLORADO
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Dates
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Enumeration Date | 05/01/2015
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Last Update Date | 05/01/2015
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Provider Practice Location Address
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Address Line | 214 8TH ST SUITE 205
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City | GLENWOOD SPRINGS
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State | CO
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Zip | 81601-3326
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Country | US
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Telephone | 970-230-9315
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Fax | 970-230-9427
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Provider Business Mailing Address
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Address Line | 214 8TH ST SUITE 205
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City | GLENWOOD SPRINGS
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State | CO
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Zip | 81601-3326
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Country | US
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Telephone | 970-230-9315
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Fax | 970-230-9427
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Authorized Official
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Title or Position | OWNER AND PROVIDER OF LLC
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Name | MS. MARGARET JEAN WEAR
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Credential | MSN FNP-C
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Telephone | 970-230-9315
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 0078099
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License Number State | CO
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