Provider Demographics
NPI:1578594727
Name:KC MEDICAL PC
Entity Type:Organization
Organization Name:KC MEDICAL PC
Other - Org Name:FOUNDERS FAMILY MEDICAL CENTER AND URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:KLEINERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-688-8666
Mailing Address - Street 1:4386 TRAIL BOSS DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-7512
Mailing Address - Country:US
Mailing Address - Phone:303-688-8666
Mailing Address - Fax:303-688-8260
Practice Address - Street 1:4386 TRAIL BOSS DR
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-7512
Practice Address - Country:US
Practice Address - Phone:303-688-8666
Practice Address - Fax:303-688-8260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO44931841Medicaid
CO803544Medicare ID - Type UnspecifiedGROUP NUMBER