Organization
PHC-FORT MORGAN INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM M. GRACEY (COO)
(615) 372-8500
Entity
Organization
Contact information
Practice address
1000 LINCOLN ST, FORT MORGAN, CO 80701-3210
(970) 867-3391
(970) 542-3306
Mailing address
1000 LINCOLN ST, CS4200, FORT MORGAN, CO 80701-3210
(970) 867-3391
(970) 542-3306
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207RP1001X
Pulmonary Disease Physician
—
—
207UN0901X
Nuclear Cardiology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
92353886
—
CO
Enumeration date
05/19/2006
Last updated
09/09/2008
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