# CENTENNIAL MEDICAL CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1568515492
- **Authorized official:** JENNY RILEY (OFFICE MANAGER)
- **Authorized official phone:** (970) 667-3565

## Contact information

- **Practice address:** 232 W 4TH ST, LOVELAND, CO 80537-5525
- **Practice address phone:** (970) 667-3565
- **Practice address fax:** (970) 667-2343
- **Mailing address:** 232 W 4TH ST, LOVELAND, CO 80537-5525
- **Mailing address phone:** (970) 667-3565
- **Mailing address fax:** (970) 667-2343

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 15838 | CO | Yes |
| 207R00000X | Internal Medicine Physician | 22781 | CO | — |

## Other

- **Enumeration date:** 01/22/2007
- **Last updated:** 09/26/2007