Provider Demographics
NPI:1235185794
Name:SOUTHEAST FAMILY PRACTICE ASSOCIATES P C
Entity Type:Organization
Organization Name:SOUTHEAST FAMILY PRACTICE ASSOCIATES P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-777-0577
Mailing Address - Street 1:950 E HARVARD AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-7009
Mailing Address - Country:US
Mailing Address - Phone:303-777-0577
Mailing Address - Fax:303-777-1197
Practice Address - Street 1:950 E HARVARD AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-7009
Practice Address - Country:US
Practice Address - Phone:303-777-0577
Practice Address - Fax:303-777-1197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04637047Medicaid
COSE63704OtherBLUE SHIELD
COCS2243OtherRAILROAD MEDICARE
COSE63704OtherBLUE SHIELD