Provider Demographics
NPI:1750422275
Name:WALSEN CLINIC
Entity type:Organization
Organization Name:WALSEN CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RECEPTIONIST BILLING
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONA
Authorized Official - Middle Name:
Authorized Official - Last Name:VIGIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-738-3164
Mailing Address - Street 1:711 WALSEN AVE. SUITE B
Mailing Address - Street 2:
Mailing Address - City:WALSENBURG
Mailing Address - State:CO
Mailing Address - Zip Code:81089
Mailing Address - Country:US
Mailing Address - Phone:719-738-3164
Mailing Address - Fax:719-738-3165
Practice Address - Street 1:711 WALSEN AVE STE B
Practice Address - Street 2:
Practice Address - City:WALSENBURG
Practice Address - State:CO
Practice Address - Zip Code:81089-2406
Practice Address - Country:US
Practice Address - Phone:719-738-3164
Practice Address - Fax:719-738-3165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service