Provider Demographics
NPI:1164574562
Name:WHEAT RIDGE FAMILY PHYSICIANS LLC
Entity Type:Organization
Organization Name:WHEAT RIDGE FAMILY PHYSICIANS LLC
Other - Org Name:HIGHLANDS FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:GARDUNO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-420-1297
Mailing Address - Street 1:4500 W 38TH AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80212
Mailing Address - Country:US
Mailing Address - Phone:303-420-1297
Mailing Address - Fax:303-420-2953
Practice Address - Street 1:4500 W 38TH AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80212
Practice Address - Country:US
Practice Address - Phone:303-420-1297
Practice Address - Fax:303-420-2953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08550573Medicaid
CO08550573Medicaid