Provider Demographics
NPI:1629204250
Name:OLATHE MEDICAL CLINIC LTD
Entity Type:Organization
Organization Name:OLATHE MEDICAL CLINIC LTD
Other - Org Name:OLATHE MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT OPERATIONS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:COO
Authorized Official - Phone:970-240-7398
Mailing Address - Street 1:2233 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-3831
Mailing Address - Country:US
Mailing Address - Phone:970-249-3700
Mailing Address - Fax:970-497-8410
Practice Address - Street 1:320 N. 3RD STREET
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:CO
Practice Address - Zip Code:81425-0000
Practice Address - Country:US
Practice Address - Phone:970-323-6141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-10
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO063989Medicare PIN