444 Wellness LLC
Organization Active NPI Interventional Pain Medicine Physician · Granby, CO
NPI 1619600285 · NPPES record last updated Aug 7, 2023
Key facts
- NPI
- 1619600285
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Interventional Pain Medicine Physician 208VP0014X
- Legal business name
- 444 WELLNESS LLC
- Practice address
- 60 North Second St
Granby, CO 80446 - Phone
- (970) 557-4040
- NPI assigned
- Jul 1, 2022
- Organization subpart
- No
Authorized official
- Name
- Kathleen Hornbaker, CRNA
- Title
- Owner
- Phone
- (970) 794-6444
Practitioners 3
-
Kathleen M Hornbaker, CRNA
-
Kellie Logue, CRNA
-
Robert Craig Ratcliff, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CO, IA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20220915003690 | CO | Part B Supplier - Clinic/Group Practice | 6204211998 |
Receives reassigned benefits from 3 practitioners Practice locations: Granby, CO |
| O20230913000597 | IA | Part B Supplier - Clinic/Group Practice | 6204211998 |
Receives reassigned benefits from 1 practitioner Practice locations: Manchester, IA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Interventional Pain Medicine Physician |
208VP0014X | Yes |
Addresses
Primary practice location
60 North Second St
Granby, CO 80446
Mailing address
PO Box 634
Granby, CO 80446-0634
Phone (309) 202-1693
Other providers in Granby, CO
- Mabon Acord
- Linda Andersson-Riggs
- Andrew W Burns DDS PC
- Lisa Marie Ansell
- Aspen Wind Counseling, LLC
All providers in Granby, CO · Interventional Pain Medicine Physician 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 7, 2023. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.