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CANON PROFESSIONAL, L.L.C.
NPI 1568625549
Clinic/Center - Primary Care in Canon City, CO

Active since July 09, 2008CLIA 06D0881220 · Waiver
730 MACON AVE, CANON CITY, CO 81212(719) 275-1618(719) 275-7334 Get Directions Write a Review

NPPES record last updated: July 9, 2008. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Canon Professional, L.l.c. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CANON PROFESSIONAL, L.L.C. (NPI 1568625549) is a healthcare organization registered as a primary care in Canon City, Colorado and active in the NPI registry since July 2008. The organization holds a CLIA Waiver certificate valid through December 9, 2026 and lists Gary Alan Mohr, Owner, as its authorized official.

NPPES Registry Identity

NPI1568625549
Entity TypeOrganization
Primary Taxonomy261QP2300X
Legal Business NameCANON PROFESSIONAL, L.L.C.
Location Address730 MACON AVECanon City, CO 81212-3314
Mailing Address730 Macon AveCanon City, CO 81212-3314 · (719) 275-1618 · Fax (719) 275-7334
Phone(719) 275-1618
Fax(719) 275-7334
Organization SubpartNo
Authorized OfficialGary Alan MohrOwner · (719) 275-1618
Enumeration DateJuly 9, 2008
✔ NPI 1568625549 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Primary CareAmbulatory Health Care Facilities
Taxonomy Code261QP2300X
License✔ Licensed in CO · 24731
730 MACON AVE, Canon City, CO 81212
Open in Google Maps ↗

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 06D0881220

Canon Professional Wellness Clinic, LLC · Canon City, CO
Active · expires Dec 9, 2026
CLIA Number06D0881220
Laboratory TypePhysician Office
Certificate Effective DateDecember 10, 2024
Certificate Expiration DateDecember 9, 2026
Laboratory DirectorLeslie K. Nelson
Laboratory Phone(719) 275-1618
Laboratory LocationCanon Professional Wellness Clinic, LLC730 Macon Avenue, Canon City, CO 81212
CLIA data matches this NPI record on: Address Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SHEILA REPKA NP
Nurse Practitioner (Family)
730 MACON AVE
CANON CITY, CO 81212
Fremont County (719) 275-1618
DR. GARY ALAN MOHR M.D.
Family Medicine
730 MACON AVE
CANON CITY, CO 81212
Fremont County (719) 275-1618
LESLIE NELSON FNP
Nurse Practitioner (Family)
730 MACON AVE
CANON CITY, CO 81212
Fremont County (719) 275-1618
CANON PROFESSIONAL WELLNESS CLINIC LLC
Nurse Practitioner (Primary Care)
730 MACON AVE
CANON CITY, CO 81212
Fremont County (719) 275-1618

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Canon Professional, L.L.C.'s NPI number?

The NPI number for Canon Professional, L.L.C. is 1568625549. It was assigned to this organization in the NPPES registry on July 9, 2008.

Where is Canon Professional, L.L.C. located?

Canon Professional, L.L.C. is located at 730 Macon Ave, Canon City, CO 81212. The listed phone number is (719) 275-1618.

What is Canon Professional, L.L.C.'s specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.

Does Canon Professional, L.L.C. hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 06D0881220) is associated with this NPI, valid through December 9, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Canon Professional, L.L.C. was last updated on July 9, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.