Organization
MARILLAC CLINIC, INC.
Active
Organization
MARILLAC CLINIC, INC.
Active
Other names
PrimeHealthplus
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LATA RAMACHANDRAN (EXECUTIVE DIRECTOR)
(970) 200-1600
Entity
Organization
Contact information
Practice address
526 29 1/2 RD, GRAND JUNCTION, CO 81504-0000
(970) 200-1600
(970) 692-8301
Mailing address
526 29 1/2 RD, GRAND JUNCTION, CO 81504-0000
(970) 200-1600
(970) 692-8301
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
—
39400247
—
CO
05
—
72071362
—
CO
05
—
90252365
—
CO
Enumeration date
01/27/2012
Last updated
09/05/2025
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