Provider Demographics
NPI:1225326663
Name:FOOTHILLS INTERNAL MEDICINE OF COLORADO LLC
Entity Type:Organization
Organization Name:FOOTHILLS INTERNAL MEDICINE OF COLORADO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMEIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLANDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-933-5338
Mailing Address - Street 1:10579 BRADFORD RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80127-4274
Mailing Address - Country:US
Mailing Address - Phone:303-933-5338
Mailing Address - Fax:303-997-8474
Practice Address - Street 1:10579 BRADFORD RD
Practice Address - Street 2:SUITE 110
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80127-4274
Practice Address - Country:US
Practice Address - Phone:303-933-5338
Practice Address - Fax:303-997-8474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-19
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO37259207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO68121547Medicaid
COG80278Medicare UPIN
COCO303374Medicare PIN