Keene Clinic
Organization Active NPI Primary Care Clinic/Center · Keenesburg, CO
NPI 1205016136 · NPPES record last updated Feb 15, 2011
Key facts
- NPI
- 1205016136
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Primary Care Clinic/Center 261QP2300X
- Legal business name
- KEENE CLINIC
- Practice address
- 190 S Main Street
Keenesburg, CO 80643-0559 - Phone
- (303) 732-4268
- Fax
- (303) 732-9288
- NPI assigned
- Nov 8, 2007
- Organization subpart
- No
Authorized official
- Name
- Benjamin Martinez-Andujo, NP
- Title
- Ceo
- Phone
- (303) 732-4268
Practitioners 9
-
Larissa Kaye Kreutzer, FNP-C
-
Olivia Amoakowaa, DNP, FNP-BC
-
Vanessa Sue Burnham, FNP-BC
-
Nora Kathryn Keane, FNP-BC
-
Carolyn Gubelin, FNP
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 06D0949991 | Keene Clinic | Provider-performed microscopy | Aug 16, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040907000316 | CO | Part B Supplier - Clinic/Group Practice | 9638145196 |
Receives reassigned benefits from 6 practitioners Practice locations: Keenesburg, CO |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Clinic/Center | 261QP2300X | Yes |
Addresses
Primary practice location
190 S Main Street
Keenesburg, CO 80643-0559
Mailing address
190 S Main Street
PO Box 559
Keenesburg, CO 80643-0559
Phone (303) 732-4268
Other providers in Keenesburg, CO
- All About Smiles Inc.
- Assisted Living of Keenesburg LLC
- Hector Juan Brignoni
- Charleston at Keenesburg, LLC
- Nora Kathryn Keane
- Love Never Fails LLC
- Madison Senior Living Management LLC
- Lauren Madsen
- Benjamin Martinez-Andujo
- Angela S Riemer
All providers in Keenesburg, CO · Primary Care Clinic/Center in Colorado
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 15, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.