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Organization
HAVENS FAMILY CLINIC
Active
Organization
HAVENS FAMILY CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASON MORGAN PA (OFFICE MANAGER)
(719) 276-3211
Entity
Organization
Contact information
Practice address
109 LATIGO LN, SUITE C, CANON CITY, CO 81212-8112
(719) 276-3211
Mailing address
109 LATIGO LN, SUITE C, CANON CITY, CO 81212-8112
(719) 276-3211
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
28791
CO
363A00000X
Physician Assistant
2124
CO
363L00000X
Nurse Practitioner
NP4805
CO
Other
Enumeration date
02/19/2007
Last updated
03/23/2012
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