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
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1205816949
INDIVIDUAL NPI NUMBER
CO
01
—
1831176924
INDIVIDUAL PROVIDER NPI
CO
05
—
74402374
—
CO
Enumeration date
02/19/2007
Last updated
03/23/2012
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