Provider Demographics
NPI:1396338901
Name:ALIGN MEDICAL CENTER
Entity type:Organization
Organization Name:ALIGN MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:SPEETZEN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:320-420-3961
Mailing Address - Street 1:6557 BUTTERCUP DR UNIT 6
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:CO
Mailing Address - Zip Code:80549-2396
Mailing Address - Country:US
Mailing Address - Phone:320-420-3961
Mailing Address - Fax:
Practice Address - Street 1:6557 BUTTERCUP DR UNIT 6
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:CO
Practice Address - Zip Code:80549-2396
Practice Address - Country:US
Practice Address - Phone:307-222-2337
Practice Address - Fax:970-363-1441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-15
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1386125631Medicaid