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NPI Code Detail

MEDICARE: INTERNAL MEDICINE CLINIC INC.

MEDICARE: INTERNAL MEDICINE CLINIC INC.
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
1174400000XSpecialist12-06712CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1881725844
Entity Type Code : Organization
Provider Name (Legal Business Name) : INTERNAL MEDICINE CLINIC INC.
Provider Business Mailing Address
First Line : 2021 BATTLECREEK DR UNIT B
Second Line :
City : FORT COLLINS
State : CO
Zip : 80528-5120
Country : US
Telephone Number : 970-224-9508
Fax Number : 970-999-3428
Provider Business Practice Location Address
First Line : 2021 BATTLECREEK DR UNIT B
Second Line :
City : FORT COLLINS
State : CO
Zip : 80528-5120
Country : US
Telephone Number : 970-224-9508
Fax Number : 970-993-4289
Authorized Official
Title or Position : PRACTICE ADMIN
Name : MRS. ALICIA D GOOSSENS
Credential :
Telephone Number : 970-224-9508
Provider Enumeration Date : 03/08/2007
Last Update Date : 12/04/2020

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Directions to “INTERNAL MEDICINE CLINIC INC. ” Practice Location

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