Aspen Leaf Internal Medicine, P.C.
Organization Active NPI Internal Medicine Physician · Grand Junction, CO
NPI 1629260237 · NPPES record last updated Aug 16, 2007
Key facts
- NPI
- 1629260237
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 37446 (CO)
- Legal business name
- ASPEN LEAF INTERNAL MEDICINE, P.C.
- Practice address
- 751 Horizon CT Ste 202
Grand Junction, CO 81506-8718 - Phone
- (970) 242-4145
- Fax
- (970) 242-4134
- NPI assigned
- Aug 16, 2007
- Organization subpart
- No
Authorized official
- Name
- Kelly Ann King, M.D.
- Title
- President
- Phone
- (970) 242-4145
Practitioners 2
-
Kelly King, M.D.
-
Anita Alexandra, L.A.C.- LICENSED ACU
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040302000318 | CO | Part B Supplier - Clinic/Group Practice | 6608763982 |
Receives reassigned benefits from 1 practitioner Practice locations: Grand Junction, CO |
National Provider Directory
Locations
751 Horizon Ct
Ste 202
Grand Junction, CO 81506
Phone (970) 242-4145
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician |
207R00000X | 37446 | CO | Yes |
Addresses
Primary practice location
751 Horizon CT Ste 202
Grand Junction, CO 81506-8718
Mailing address
751 Horizon CT Ste 202
Grand Junction, CO 81506-8718
Phone (970) 242-4145
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 49959549 | Medicaid | CO |
Other providers in Grand Junction, CO
- Ashley Ford, OD, PLLC
- Ashley Walsh LPC LLC
- Christa Marie Aslanian
- Aspen Glen Inc.
- Aspen Grove Family Practice, LLC
- Aspen Meadows Assisted Living, LLC
- Aspire Neurobehavioral Counseling
- Associates in Behavioral Counseling, LLC
- Patricia Atchison
- Karen Schloemer Atencio
All providers in Grand Junction, CO · Internal 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 16, 2007. 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.