MARILLAC CLINIC, INC (NPI# 1104275882) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104275882 |
| Entity Type | Organization |
| Organization Name | MARILLAC CLINIC, INC |
| Practice Address |
510 29 1/2 Rd Grand Junction CO 81504 |
| Mailing Address |
2333 N 6th St Grand Junction CO 81501-2001 |
| Practice Telephone | 9702981782 |
| Practice Fax Number | 9702981711 |
| Mailing Telephone | 9702981782 |
| Mailing Fax Number | 9702981711 |
| Enumeration Date | 2016-06-03 |
| Last Update Date | 2020-09-21 |
| Authorized Official Name | LATA RAMACHANDRAN (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 9702982235 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QD0000X |
Clinic/Center Specialization: Dental |
Ambulatory Health Care Facilities | ||
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
18U295 | CO | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CO | 15522865 | 05 | |
| CO | 38402068 | 05 | |
| CO | 90252365 | 05 | |
| CO | 27421767 | 05 | |
| CO | 72071362 | 05 |
| Street Address |
510 29 1/2 RD |
| City | GRAND JUNCTION |
| State | CO |
| Zip Code | 81504 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831201359 | Anita I Sheetz | Midwife | 510 29 1/2 Rd, Grand Junction, CO 81504-5383 | 2006-08-31 |
| 1689286239 | Amanda Jensen | Registered Nurse | 510 29 1/2 Rd, Grand Junction, CO 81504-5383 | 2020-08-17 |
| 1902380975 | Holly Nisley | Social Worker | 510 29 1/2 Rd, Grand Junction, CO 81504-5383 | 2018-09-17 |
| 1932695715 | Danielle Garcia | Registered Nurse | 510 29 1/2 Rd, Grand Junction, CO 81504-5383 | 2018-07-05 |
| 1215423074 | Keli Campbell | Registered Nurse | 510 29 1/2 Rd, Grand Junction, CO 81504-5383 | 2018-07-05 |
| 1265921571 | Danyelle Larson | Registered Nurse | 510 29 1/2 Rd, Grand Junction, CO 81504-5383 | 2018-05-02 |
| 1437648748 | Rebecca Ferguson | Registered Nurse | 510 29 1/2 Rd, Grand Junction, CO 81504-5383 | 2018-05-02 |
| 1285169334 | Melanie A Duyvejonck | Registered Nurse | 510 29 1/2 Rd, Grand Junction, CO 81504-5383 | 2017-04-26 |
| 1598128605 | Erin Andrews | Registered Nurse | 510 29 1/2 Rd, Grand Junction, CO 81504-5383 | 2016-04-05 |
| 1750752390 | Mesa County Dept of Human Services | Contractor | 510 29 1/2 Rd, Grand Junction, CO 81504-5383 | 2015-10-08 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699226936 | Ariel Kristine Rendt Padron | Counselor | 639 Long Peak Ct, Grand Junction, CO 81504 | 2016-10-21 |
| 1902197460 | Bereket Yebiyo | Pharmacist | 2992 F Rd., Grand Junction, CO 81504 | 2011-05-02 |
| 1467636787 | Renae Tabin | Physician Assistant | 569 32 Rd Ste 12, Grand Junction, CO 81504 | 2007-12-21 |
| 1689892069 | Mark Newhouse | Physical Therapist | 2777 Crossroads Blvd, Grand Junction, CO 81504 | 2007-04-23 |
| 1841414570 | Deborah Ann Didonato | Registered Nurse | 510 29 .5 Rd, Grand Junction, CO 81504 | 2007-04-12 |
| 1073634952 | Darilynn Sue Maddux | Technician | 510 29.5, Grand Junction, CO 81504 | 2007-04-02 |
| 1538289749 | Shirley Callaway | Registered Nurse | 510 29. 5 Road, Grand Junction, CO 81504 | 2007-03-30 |
| 1407891328 | Dillon Companies LLC | Durable Medical Equipment & Medical Supplies | 569 32 Rd, Grand Junction, CO 81504 | 2006-06-17 |
| 1275536146 | Mesa County Health Department | Registered Nurse | 510 29 1/2 Road, Grand Junction, CO 81504 | 2005-05-24 |
| 1255722054 | Margaret Lorraine Lehr | Nurse Practitioner | 3096 I-70 Business Loop, Suite D, Grand Junction, CO 81504 | 2015-02-16 |
| Find all providers in zip 81504 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093345886 | Marillac Clinic, Inc. | Clinic/Center | 550 Warrior Way, Grand Junction, CO 81504-6401 | 2020-01-21 |
| 1497103212 | Marillac Clinic, Inc. | Clinic/Center | 2853 North Ave, Grand Junction, CO 81501 | 2016-06-02 |
| 1063861748 | Marillac Clinic, Inc. | Clinic/Center | 3150 N 12th St, Grand Junction, CO 81506 | 2016-06-03 |
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| Find all providers with the same taxonomy | ||||
| City | GRAND JUNCTION |
| Zip Code | 81504 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.