LONGMONT CLINIC PC (NPI# 1043269772) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1043269772 |
Entity Type | Organization |
Organization Name | LONGMONT CLINIC PC |
Practice Address |
1925 W Mountain View Ave Longmont CO 80501-3128 |
Practice Telephone | 7204943173 |
Practice Fax Number | 7204943107 |
Mailing Telephone | 7204943173 |
Mailing Fax Number | 7204943107 |
Enumeration Date | 2006-05-09 |
Last Update Date | 2013-12-12 |
Authorized Official Name | JOHN P. STATHIS (PRESIDENT, BOARD OF DIRECTORS) |
Authorized Official Telephone | 7204943173 |
Authorized Official Credential | M.D. |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 208D00000X | General Practice | Allopathic & Osteopathic Physicians |
State | Issuer | Identifier | Type Code |
---|---|---|---|
CO | MEDICARE GROUP NUMBER | 44008 | 01 |
Street Address |
1925 W MOUNTAIN VIEW AVE |
City | LONGMONT |
State | CO |
Zip Code | 80501-3128 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1467456889 | Marie Bush | Internal Medicine | 1925 W Mountain View Ave, Longmont, CO 80501-3128 | 2005-06-13 |
1871893818 | Kimberly J Welch | Dietitian, Registered | 1925 W Mountain View Ave, Longmont, CO 80501-3128 | 2010-10-25 |
1225351844 | Sheryl A Bachman | Dietitian, Registered | 1925 W Mountain View Ave, Longmont, CO 80501-3128 | 2010-03-10 |
1285812958 | Vanessa Lea Pomfret | Registered Nurse | 1925 W Mountain View Ave, Longmont, CO 80501-3128 | 2008-02-05 |
1063600096 | Katherine Dueber | Pediatrics | 1925 W Mountain View Ave, Longmont, CO 80501-3128 | 2007-10-03 |
1235277104 | Robert J Moffat | Internal Medicine | 1925 W Mountain View Ave, Longmont, CO 80501-3128 | 2007-02-02 |
1285799056 | Abby C Emdur | Otolaryngology | 1925 W Mountain View Ave, Longmont, CO 80501-3128 | 2006-12-22 |
1184675258 | Jalpa B Kim | Obstetrics & Gynecology | 1925 W Mountain View Ave, Longmont, CO 80501-3128 | 2006-05-13 |
1689635609 | Janelle C Laughlin | Internal Medicine | 1925 W Mountain View Ave, Longmont, CO 80501-3128 | 2006-03-29 |
1770550899 | Melinda A Gehrs | Physical Medicine & Rehabilitation | 1925 W Mountain View Ave, Longmont, CO 80501-3128 | 2006-03-07 |
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1598376774 | Boulder County Public Health | Public Health or Welfare | 515 Coffman Street, Suite 200, Longmont, CO 80501 | 2020-08-12 |
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1861036501 | Stateserv Medical of Colorado | Durable Medical Equipment & Medical Supplies | 63 South Pratt Pkwy, Landmont, CO 80501 | 2019-11-06 |
1558915090 | Array Clinical and Therapeutic Services | Assistant Behavior Analyst | 451 21st Ave. Suite B, Longmont, CO 80501 | 2019-08-01 |
1275195042 | Alisa Marie Schwegerl | Speech-Language Pathologist | 1800 Stroh Place, Longmont, CO 80501 | 2019-07-02 |
1295298545 | Jovahna Pena | Counselor | Behavioral Health Group, 850 23rd Ave Unit A, Longmont, CO 80501 | 2019-04-12 |
1659845568 | University Physicians Incorporated | Advanced Practice Midwife | 2030 Mountain View Ave Ste 400, Longmont, CO 80501 | 2019-01-14 |
1013404714 | Crafted Physical Therapy Pllc | Physical Therapist | 701 Delaware Ave Unit E, Longmont, CO 80501 | 2018-04-18 |
1588110860 | Randall Bonnom | Counselor | 420 21st Ave #113, Longmont, CO 80501 | 2016-08-28 |
1225401771 | Sowash Optometry Group, PC | Eyewear Supplier (Equipment, not the service) | 1242 S. Hover Street, Suite C200, Longmont, CO 80501 | 2015-11-05 |
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Taxonomy Code | 208D00000X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | General Practice |
Definition to come... |
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1487800363 | Gary Fishel Gansar | General Practice | 8480 Haystack Ct, Longmont, CO 80503-7292 | 2008-08-12 |
1366465866 | Longmont United Hospital | General Practice | 1950 W Mountain View Ave, Longmont, CO 80501-3129 | 2006-07-25 |
1154937282 | Poudre Valley Medical Group, LLC | General Practice | 2900 Peak Ave, Longmont, CO 80504-6236 | 2020-09-23 |
1942822036 | Poudre Valley Medical Group, LLC | General Practice | 1750 E Ken Pratt Blvd, Longmont, CO 80504-5311 | 2020-05-12 |
1003359118 | Vcphcs X, LLC | General Practice | 850 23rd Ave, Unit A, Longmont, CO 80501-1114 | 2016-11-21 |
1093194755 | Joel Roberts | General Practice | 1351 Collyer St, Longmont, CO 80501 | 2015-05-27 |
1598932279 | Longmont United Hospital | General Practice | 1950 W Mountain View Ave, Longmont, CO 80501-3129 | 2008-05-13 |
1871620880 | Roberta L Shanahan | General Practice | 2345 Bent Way, Longmont, CO 80503-7614 | 2007-02-27 |
1669509626 | Kristi L Killgore | General Practice | 2345 Bent Way, Longmont, CO 80503-7614 | 2007-02-27 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.