Longmont Clinic PC

NPI #1043269772 in Longmont, Colorado

Provider Information

NPI Number: 1043269772
Entity Type: Organization
Organization Name: Longmont Clinic PC
Primary Specialty: General Practice
Enumeration Date: May 9, 2006
Last Updated: Dec 12, 2013

Practice Location

Address: 1925 W MOUNTAIN VIEW AVE
City: Longmont
State: Colorado
ZIP Code: 80501-3128
Phone: (720) 494-3173

Authorized Official

Name: JOHN P. STATHIS, M.D.
Title: PRESIDENT, BOARD OF DIRECTORS
Phone: (720) 494-3173

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
General Practice	208D00000X	Primary

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