Organization
INTERNAL MEDICINE CLINIC INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ALICIA D GOOSSENS (PRACTICE ADMIN)
(970) 224-9508
Entity
Organization
Contact information
Practice address
2021 BATTLECREEK DR UNIT B, FORT COLLINS, CO 80528-5120
(970) 224-9508
(970) 993-4289
Mailing address
2021 BATTLECREEK DR UNIT B, FORT COLLINS, CO 80528-5120
(970) 224-9508
(970) 999-3428
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
12-06712
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04014205
—
CO
Enumeration date
03/08/2007
Last updated
12/04/2020
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