Provider Demographics
NPI:1427299304
Name:MORGAN COMMUNITY WALK- IN CLINIC
Entity type:Organization
Organization Name:MORGAN COMMUNITY WALK- IN CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAFTU
Authorized Official - Middle Name:
Authorized Official - Last Name:GEBREHIWOT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-867-0662
Mailing Address - Street 1:411 MAIN ST STE 203
Mailing Address - Street 2:
Mailing Address - City:FORT MORGAN
Mailing Address - State:CO
Mailing Address - Zip Code:80701-2136
Mailing Address - Country:US
Mailing Address - Phone:970-867-0662
Mailing Address - Fax:970-867-0917
Practice Address - Street 1:411 MAIN ST STE 203
Practice Address - Street 2:
Practice Address - City:FORT MORGAN
Practice Address - State:CO
Practice Address - Zip Code:80701-2136
Practice Address - Country:US
Practice Address - Phone:970-867-0662
Practice Address - Fax:970-867-0917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-23
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO46877261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO28921895Medicaid