Provider Demographics
NPI:1417402918
Name:EAST WEST FAMILY HEALTH LLC
Entity Type:Organization
Organization Name:EAST WEST FAMILY HEALTH LLC
Other - Org Name:EAST-WEST HEALTH CENTERS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:FLOYD
Authorized Official - Middle Name:B
Authorized Official - Last Name:RUSSAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-591-8161
Mailing Address - Street 1:8200 E. BELLEVIEW AVENUE
Mailing Address - Street 2:SUITE 203-C
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2835
Mailing Address - Country:US
Mailing Address - Phone:303-221-6797
Mailing Address - Fax:303-221-4563
Practice Address - Street 1:8200 E. BELLEVIEW AVENUE
Practice Address - Street 2:SUITE 203-C
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2835
Practice Address - Country:US
Practice Address - Phone:303-221-6797
Practice Address - Fax:303-221-4563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-25
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO35559207Q00000X
207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COA56234Medicare UPIN