Provider Demographics
NPI:1114944121
Name:SOUTHEAST FAMILY PHYSICIANS
Entity Type:Organization
Organization Name:SOUTHEAST FAMILY PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PASH-LOHR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-706-0400
Mailing Address - Street 1:3464 S WILLOW ST
Mailing Address - Street 2:SUITE 376
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-4531
Mailing Address - Country:US
Mailing Address - Phone:303-755-2900
Mailing Address - Fax:303-755-0404
Practice Address - Street 1:10099 RIDGEGATE PKWY
Practice Address - Street 2:SUITE 340
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5531
Practice Address - Country:US
Practice Address - Phone:303-706-0400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COSOM8308OtherBLUE SHIELD
CO28585046Medicaid
CODF9202OtherRR MEDICARE
CODF9202OtherRR MEDICARE
CO28585046Medicaid