Organization
LONGMONT CLINIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN P. STATHIS M.D. (PRESIDENT, BOARD OF DIRECTORS)
(720) 494-3173
Entity
Organization
Contact information
Practice address
1925 W MOUNTAIN VIEW AVE, LONGMONT, CO 80501-3128
(720) 494-3173
(720) 494-3107
Mailing address
1925 W MOUNTAIN VIEW AVE, LONGMONT, CO 80501-3128
(720) 494-3173
(720) 494-3107
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
44008
MEDICARE GROUP NUMBER
CO
Enumeration date
05/09/2006
Last updated
12/12/2013
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