Organization
HAVENS FAMILY CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JASON MORGAN PA C (OWNER)
(719) 276-3211
Entity
Organization
Contact information
Practice address
109 LATIGO LN, SUITE C, CANON CITY, CO 81212-8112
(719) 276-3211
(719) 276-3011
Mailing address
109 LATIGO LN, SUITE C, CANON CITY, CO 81212-8112
(719) 276-3211
(719) 276-3011
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
28791
CO
363AM0700X
Medical Physician Assistant
Primary
2124
CO
363L00000X
Nurse Practitioner
NP4805
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1205816949
INDIVIDUAL NPI PROVIDER #
CO
01
—
1831176924
INDIVIDUAL NPI PROVIDER #
CO
05
—
74402374
—
CO
Enumeration date
02/28/2007
Last updated
11/12/2010
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