Organization
MARILLAC CLINIC, INC.
Active
Organization
MARILLAC CLINIC, INC.
Active
Other names
PrimeHealthplus
Organization subpart
No
Provider details
NPI number
Authorized official
LATA RAMACHANDRAN (EXECUTIVE DIRECTOR)
(970) 200-1600
Entity
Organization
Contact information
Practice address
3150 N 12TH ST, GRAND JUNCTION, CO 81506
(970) 200-1600
(970) 200-1611
Mailing address
2333 N 6TH ST, GRAND JUNCTION, CO 81501-2001
(970) 298-1782
(970) 298-1711
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
18U295
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
15522865
—
CO
05
—
27421767
—
CO
05
—
38402068
—
CO
05
—
72071362
—
CO
05
—
90252365
—
CO
Enumeration date
06/03/2016
Last updated
08/05/2025
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up