Provider Demographics
NPI:1497708440
Name:FORESIGHT FAMILY PHYSICIANS PC
Entity Type:Organization
Organization Name:FORESIGHT FAMILY PHYSICIANS PC
Other - Org Name:GARDEN VILLAGE PHYSICIANS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MCIHELLE
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:TONOZZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-242-2660
Mailing Address - Street 1:2503 FORESIGHT CIR
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505-1139
Mailing Address - Country:US
Mailing Address - Phone:970-242-2660
Mailing Address - Fax:970-242-0080
Practice Address - Street 1:2503 FORESIGHT CIR
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-1139
Practice Address - Country:US
Practice Address - Phone:970-242-2660
Practice Address - Fax:970-242-0080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COFOU8408OtherBLUE CROSS BLUE SHIELD
COCI4038OtherRAIL ROAD MEDICARE
CO04012589Medicaid
COCI4038OtherRAIL ROAD MEDICARE
CO=========OtherTAX ID NUMBER