Organization Active NPI

Keene Clinic

  • Primary Care Clinic/Center
  • Keenesburg, CO
National Provider Identifier
1205016136
Registry record updated Feb 15, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 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
Last updated
Feb 15, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2011

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

Authorized official

Name
Benjamin Martinez-Andujo, NPNPI 1952321150
Title
Ceo
Phone
(303) 732-4268

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040907000316 CO Part B Supplier - Clinic/Group Practice 9638145196 Receives reassigned benefits from 6 practitioners
Practice locations: Keenesburg, CO

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
06D0949991Keene Clinic190 S Main Street, Keenesburg, CO 80643Provider-performed microscopyAug 16, 2026

National Provider Directory

National Provider Directory

Locations

3555 Stanford Rd
Ste 106
Fort Collins, CO 80525

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1194480000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1297728000000",
    "number": "1205016136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "190 S MAIN STREET",
            "address_2": "PO BOX 559",
            "city": "KEENESBURG",
            "state": "CO",
            "postal_code": "806430559",
            "telephone_number": "303-732-4268",
            "fax_number": "303-732-9288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "190 S MAIN STREET",
            "city": "KEENESBURG",
            "state": "CO",
            "postal_code": "806430559",
            "telephone_number": "303-732-4268",
            "fax_number": "303-732-9288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEENE CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-08",
        "last_updated": "2011-02-15",
        "status": "A",
        "authorized_official_last_name": "MARTINEZ-ANDUJO",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "303-732-4268",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Keenesburg, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.