HAVENS FAMILY CLINIC NPI 1982731535

NPI Information

NPI: 1982731535
Provider Name: HAVENS FAMILY CLINIC
Classification: Physician Assistant - 363AM0700X
Entity Type: Organization

Specialization: Medical

Address:
109 LATIGO LN
SUITE C
CANON CITY, CO
ZIP 81212
Phone: (719) 276-3211
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HAVENS FAMILY CLINIC is a medical physician assistant in Canon City, CO. HAVENS FAMILY CLINIC NPI is 1982731535. 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
Fax: (719) 276-3011

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

The enumeration date for this NPI number is 2/28/2007 and was last updated on 11/12/2010.

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 Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207Q00000X	Family Medicine		28791	COLORADO	No
2	363L00000X	Nurse Practitioner		NP4805	COLORADO	No
3	363AM0700X	Physician Assistant	Medical	2124	COLORADO	Yes

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 Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	C98044	MEDICARE UPIN	COLORADO
2	1205816949	OTHER	COLORADO	INDIVIDUAL NPI PROVIDER #
3	Q38455	MEDICARE UPIN	COLORADO
4	063854	MEDICARE ID-TYPE UNSPECIFIED	COLORADO
5	74402374	MEDICAID	COLORADO
6	1831176924	OTHER	COLORADO	INDIVIDUAL NPI PROVIDER #

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

NPI Synchronization or Removal

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