Provider Demographics
NPI:1508103961
Name:ANDY M. FINE, M.D., INC
Entity Type:Organization
Organization Name:ANDY M. FINE, M.D., INC
Other - Org Name:COLORADO PRIMARY HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:M
Authorized Official - Last Name:WEBBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-703-8583
Mailing Address - Street 1:20 W DRY CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-4478
Mailing Address - Country:US
Mailing Address - Phone:303-703-8583
Mailing Address - Fax:303-703-9791
Practice Address - Street 1:20 W DRY CREEK CIR
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-4478
Practice Address - Country:US
Practice Address - Phone:303-703-8583
Practice Address - Fax:303-703-9791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-04
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO34784207R00000X
CO3227363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO42951836Medicaid
COG49580Medicare UPIN