| Organization Name: | KIECA MD PLLC |
| NPI Number: | 1013103373 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JENNIFER KIECA CRAIG (OWNER) |
| Mailing Address: | 2050 South Main Unit B Delta |
| State: | CO US |
| Postal Code: | 81416 |
| Phone Number: | 9708744473 |
| Fax Number: | 9708748681 |
| NPI Enumeration Date: | 09/20/2007 |
| NPI Last Update Date: | 01/16/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | 40224 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CO |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |