PHC-Fort Morgan Inc

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

PHC-FORT MORGAN INC

Doing business as

Colorado Plains Clinic - Wiggins

Practice address

226 Main St
Wiggins, CO 80654-1368

Phone

(970) 483-7283

NPI assigned

May 19, 2006

Last updated

Aug 20, 2007By the provider in NPPES

Organization subpart

Yes

Parent organization

PHC-FORT MORGAN INCAs reported in NPPES

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

Authorized official

Name

William M. Gracey

Title

Coo

Phone

(615) 372-8500

Specialties & licenses 1

Addresses

Other names 1

• Colorado Plains Clinic - Wiggins Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1265486930. Details of each certification follow.

• CCN 063864 Rural health clinic · Active · Name & address match · Details

Rural health clinic certification: CCN 063864

Legal name

COLORADO PLAINS CLINIC - WIGGINS

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Nov 8, 2005

Last certification

Oct 13, 2005

Ownership / control type

1B

Facility address

226 Main Street
Wiggins, CO 80654

Part of

PHC-Fort Morgan Inc

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1187568000000",
    "number": "1265486930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 POWELL CT",
            "address_2": "STE. 200",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370275079",
            "telephone_number": "615-372-8500",
            "fax_number": "615-372-8572"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "226 MAIN ST",
            "city": "WIGGINS",
            "state": "CO",
            "postal_code": "806541368",
            "telephone_number": "970-483-7283"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHC-FORT MORGAN INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PHC-FORT MORGAN INC",
        "enumeration_date": "2006-05-19",
        "last_updated": "2007-08-20",
        "status": "A",
        "authorized_official_last_name": "GRACEY",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "615-372-8500"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Colorado Plains Clinic - Wiggins",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Chunxia Leonhardt
• Elizabeth Marquez Gomes
• Lynette Mayes, RN
• Corazon De Jesus Mendez
• Morgan County District 50J
• Sydney Rochelle Romero
• Clark Wayne Seele, RPH
• Kathleen A Wecher
• Your Home Operations, LLC

• Rural Health Clinic/Center in Wiggins, CO
• Providers in Wiggins, CO by specialty
• Rural Health Clinic/Center in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.