Organization Name: | LONGMONT CLINIC PC |
NPI Number: | 1043269772 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JOHN P. STATHIS (PRESIDENT, BOARD OF DIRECTORS) |
Mailing Address: | 1925 W Mountain View Ave Longmont |
State: | CO US |
Postal Code: | 805013128 |
Phone Number: | 7204943173 |
Fax Number: | 7204943107 |
NPI Enumeration Date: | 05/09/2006 |
NPI Last Update Date: | 12/12/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |