NPIMap

Organization Active NPI

Marillac Clinic, Inc.

Doing business as PrimeHealthplus

  • Federally Qualified Health Center (FQHC)
  • Grand Junction, CO
National Provider Identifier
1063861748
Registry record updated Aug 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
18U295 Issued in CO
Legal business name
MARILLAC CLINIC, INC.
Doing business as
PrimeHealthplus
Practice address
3150 N 12TH St
Grand Junction, CO 81506
Phone
(970) 200-1600
Fax
(970) 200-1611
NPI assigned
Jun 3, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Lata Ramachandran
Title
Executive Director
Phone
(970) 200-1600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 18U295 CO Primary

Addresses

Primary practice location

3150 N 12TH St
Grand Junction, CO 81506

Mailing address

2333 N 6TH St
Grand Junction, CO 81501-2001
Phone (970) 298-1782

Other identifiers 5

IdentifierTypeStateIssuer
38402068MedicaidCO
72071362MedicaidCO
90252365MedicaidCO
15522865MedicaidCO
27421767MedicaidCO

Other names 1

  • PrimeHealthplus Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Federally qualified health center certification: CCN 061004

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
MARILLAC HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 17, 2019
Last certification
Jun 17, 2019
Ownership / control type
For profit – corporation
Facility address
3150 North 12TH Avenue
Grand Junction, CO 81506

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1464912000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1754352000000",
    "number": "1063861748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2333 N 6TH ST",
            "city": "GRAND JUNCTION",
            "state": "CO",
            "postal_code": "815012001",
            "telephone_number": "970-298-1782",
            "fax_number": "970-298-1711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3150 N 12TH ST",
            "city": "GRAND JUNCTION",
            "state": "CO",
            "postal_code": "81506",
            "telephone_number": "970-200-1600",
            "fax_number": "970-200-1611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARILLAC CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-03",
        "last_updated": "2025-08-05",
        "certification_date": "2025-08-05",
        "status": "A",
        "authorized_official_last_name": "RAMACHANDRAN",
        "authorized_official_first_name": "LATA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "970-200-1600"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CO",
            "license": "18U295",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38402068",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "72071362",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "90252365",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "15522865",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "27421767",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PrimeHealthplus",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Grand Junction, CO

Sources for this page

Verify at the official NPI Registry.