MEDICARE: HEATHER FARMER PAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PAL1916	CO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00119102	OTHER	CO	RAIL ROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CH667362	OTHER	CO	BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316909567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER FARMER PAC

Provider Business Mailing Address
First Line	:	2503 FORESIGHT CIR
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81505-1139
Country	:	US
Telephone Number	:	970-242-2660
Fax Number	:	970-242-0080

Provider Business Practice Location Address
First Line	:	2570 PATTERSON RD
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81505-1438
Country	:	US
Telephone Number	:	970-298-6601
Fax Number	:	970-298-6641

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2006
Last Update Date	:	10/13/2021

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Directions to “ HEATHER FARMER PAC” Practice Location

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