Colorado Center for Lifestyle Medicine
Organization Active NPI Family Nurse Practitioner · Salida, CO
NPI 1558099119 · NPPES record last updated Aug 11, 2022
Key facts
- NPI
- 1558099119
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- Legal business name
- COLORADO CENTER FOR LIFESTYLE MEDICINE
- Practice address
- 301 Oak St Unit a
Salida, CO 81201-3340 - Phone
- (719) 207-4083
- NPI assigned
- Aug 11, 2022
- Organization subpart
- No
Authorized official
- Name
- Bronwyn Radcliffe
- Title
- Owner
- Phone
- (719) 207-4083
Practitioners 2
-
Janelle Wolek Marino, NP-C
-
Bronwyn Kathleen Radcliffe, F.N.P.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 06D2273824 | Colorado Center for Lifestyle Medicine, the | Certificate of waiver | Dec 19, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20220915000123 | CO | Part B Supplier - Clinic/Group Practice | 3971988783 |
Receives reassigned benefits from 2 practitioners Practice locations: Salida, CO |
National Provider Directory
Locations
301 Oak St
Unit A
Salida, CO 81201
Phone (719) 207-4083
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner |
363LF0000X | Yes |
Addresses
Primary practice location
301 Oak St Unit a
Salida, CO 81201-3340
Mailing address
PO Box 827
Salida, CO 81201-0827
Other providers in Salida, CO
- Cloud 9 Chiropractic and Day Spa
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- Coalescence Health PLLC
- Staci Rene Coberly
- Collegiate Peaks Counseling, LLC
- Complementary Medicine Clinic, LLC
- Lauren Cone
- Connectivity Counseling, LLC.
- Donna N Constance
- Amy B Cope
All providers in Salida, CO · Family Nurse Practitioner in Colorado
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 11, 2022. 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.