| Organization Name: | FORT MORGAN MEDICAL GROUP, PC |
| NPI Number: | 1396791646 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | REBECCA HEPWORTH (BUSINESS MANAGER) |
| Mailing Address: | 102 W 9th Ave Fort Morgan |
| State: | CO US |
| Postal Code: | 807012012 |
| Phone Number: | 9708675681 |
| Fax Number: | 9708677361 |
| NPI Enumeration Date: | 05/26/2006 |
| NPI Last Update Date: | 04/18/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QH0100X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Health Service |
| Taxonomy Definition: | |