Provider Demographics
NPI:1750592655
Name:OPEN BIBLE MEDICAL CLINIC
Entity type:Organization
Organization Name:OPEN BIBLE MEDICAL CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PASTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFERSON
Authorized Official - Middle Name:D
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:719-475-0972
Mailing Address - Street 1:555 E COSTILLA ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-3764
Mailing Address - Country:US
Mailing Address - Phone:719-475-0972
Mailing Address - Fax:719-475-0322
Practice Address - Street 1:555 E COSTILLA ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-3764
Practice Address - Country:US
Practice Address - Phone:719-596-4449
Practice Address - Fax:719-574-6686
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OPEN BIBLE BAPTIST CHURCH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-24
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health