Provider Demographics
NPI:1376574228
Name:LA CLINICA CAMPESINA FAMILY HEALTH SERVICES
Entity Type:Organization
Organization Name:LA CLINICA CAMPESINA FAMILY HEALTH SERVICES
Other - Org Name:CLINICA CAMPESINA FAMILY HEALTH SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PETE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEIBIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-665-3036
Mailing Address - Street 1:1345 PLAZA CT N
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-3531
Mailing Address - Country:US
Mailing Address - Phone:303-665-3036
Mailing Address - Fax:303-665-3397
Practice Address - Street 1:90 HEALTH PARK DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-9757
Practice Address - Country:US
Practice Address - Phone:303-665-3036
Practice Address - Fax:303-665-3397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0385261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health