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HAVENS FAMILY CLINIC NPI 1619011830


NPI Information

NPI: 1619011830
Provider Name: HAVENS FAMILY CLINIC
Classification: Family Medicine - 207Q00000X
Entity Type: Organization
Address:
109 LATIGO LN
SUITE C
CANON CITY, CO
ZIP 81212
Phone: (719) 276-3211
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HAVENS FAMILY CLINIC is a family medicine in Canon City, CO. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. HAVENS FAMILY CLINIC NPI is 1619011830. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

109 LATIGO LN
SUITE C
CANON CITY, CO
ZIP 81212-112
Phone: (719) 276-3211

The provider's authorized official is Jason Morgan .
The authorized official title is Office Manager and has the following contact phone number (719) 276-3211.

The enumeration date for this NPI number is 2/19/2007 and was last updated on 3/23/2012.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1363A00000XPhysician Assistant2124COLORADONo
2363L00000XNurse PractitionerNP4805COLORADONo
3207Q00000XFamily Medicine28791COLORADOYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1Q38455MEDICARE UPINCOLORADO
2824694512MEDICARE ID-TYPE UNSPECIFIEDCOLORADO
3262008MEDICARE ID-TYPE UNSPECIFIEDCOLORADO
4262018MEDICARE ID-TYPE UNSPECIFIEDCOLORADO
5C98044MEDICARE UPINCOLORADO
674402374MEDICAIDCOLORADO
71205816949OTHERCOLORADOINDIVIDUAL NPI NUMBER
81831176924OTHERCOLORADOINDIVIDUAL PROVIDER NPI
9000097212MEDICARE ID-TYPE UNSPECIFIEDCOLORADO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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