Provider Demographics
NPI:1386181493
Name:DIRECT OSTEOPATHIC PRIMARY CARE
Entity Type:Organization
Organization Name:DIRECT OSTEOPATHIC PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIEANNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SEEFELDT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:303-422-2236
Mailing Address - Street 1:16 LAKESIDE LN
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80212-7413
Mailing Address - Country:US
Mailing Address - Phone:303-422-2236
Mailing Address - Fax:720-360-0266
Practice Address - Street 1:16 LAKESIDE LN
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80212-7413
Practice Address - Country:US
Practice Address - Phone:303-422-2236
Practice Address - Fax:720-360-0266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-26
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO50338207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO64370348Medicaid
CO1548402449OtherNPI PROVIDER