MARILLAC CLINIC, INC. (NPI# 1497103212) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497103212 |
| Entity Type | Organization |
| Organization Name | MARILLAC CLINIC, INC. |
| Practice Address |
2853 North Ave Grand Junction CO 81501 |
| 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 | 2016-06-02 |
| 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 |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
18U295 | CO | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CO | 72071362 | 05 | |
| CO | 15522865 | 05 | |
| CO | 90252365 | 05 | |
| CO | 38402068 | 05 | |
| CO | 27421767 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093345886 | Marillac Clinic, Inc. | Clinic/Center | 550 Warrior Way, Grand Junction, CO 81504-6401 | 2020-01-21 |
| 1093163800 | Marillac Clinic, Inc. | Clinic/Center | 302 Pitkin 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 |
| 1871865576 | Marillac Clinic, Inc. | Optometrist | 2333 N 6th St, Grand Junction, CO 81501 | 2012-01-27 |
| 1518239219 | Marillac Clinic, Inc. | Physician Assistant | 2333 N 6th St, Grand Junction, CO 81501 | 2012-01-27 |
| Street Address |
2853 NORTH AVE |
| City | GRAND JUNCTION |
| State | CO |
| Zip Code | 81501 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982210266 | Sarah Cubbage | Student in an Organized Health Care Education/Training Program | 2853 North Ave, Grand Junction, CO 81501-5040 | 2020-09-22 |
| 1033725742 | Lindsi Grace Peters | Student in an Organized Health Care Education/Training Program | 2853 North Ave, Grand Junction, CO 81501-5040 | 2020-09-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700430261 | Brianne Tanae Harper | Physician Assistant | 2530 N 8th St Suite 205, Grand Junction, CO 81501 | 2019-08-01 |
| 1497318059 | Shellen H Pinnt | Counselor | 660 White Avene, Grand Junction, CO 81501 | 2019-04-19 |
| 1477011658 | Gaylene Ludwig | Counselor | 622 Rood Ave, Grand Junction, CO 81501 | 2019-03-07 |
| 1639676158 | Chris De Bruin | Counselor | Grand Junction Metro Treatment Center, 1001 Wellington Ave, Grand Junction, CO 81501 | 2018-04-11 |
| 1568971125 | Michael Sprague | Counselor | 1001 Wellington Avenue, Grand Junction, CO 81501 | 2017-09-27 |
| 1609393560 | Karin Vandervelde | Midwife | 2241 7th Street, Bloomin' Babies Birth Center, Grand Junction, CO 81501 | 2017-08-23 |
| 1225550361 | Critical Nurse Staffing, LLC | Home Health | 1114 N 1st St, Suite 200, Grand Junction, CO 81501 | 2017-07-11 |
| 1003344094 | Mac Aarron Fish | Counselor | 622 Rood Ave Ste C, Grand Junction, CO 81501 | 2017-06-02 |
| 1467994566 | A New Life Counseling, Inc | Counselor | 623 North 8th St, Grand Junction, CO 81501 | 2016-11-07 |
| 1801342597 | Paragon Restoration & Building, Inc. | Contractor | 205 S. 15th St., Grand Junction, CO 81501 | 2016-09-01 |
| Find all providers in zip 81501 | ||||
| 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 |
| 1063861748 | Marillac Clinic, Inc. | Clinic/Center | 3150 N 12th St, Grand Junction, CO 81506 | 2016-06-03 |
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| 1639714041 | Peak Vista Community Health Centers | Clinic/Center | 4041 E San Miguel St, Colorado Springs, CO 80909 | 2019-11-08 |
| Find all providers with the same taxonomy | ||||
| City | GRAND JUNCTION |
| Zip Code | 81501 |
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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.