Provider Demographics
NPI:1578625174
Name:MOUNTAIN FAMILY HEALTH CENTERS
Entity Type:Organization
Organization Name:MOUNTAIN FAMILY HEALTH CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:GRIFFITH
Authorized Official - Last Name:ADAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-945-2840
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:NEDERLAND
Mailing Address - State:CO
Mailing Address - Zip Code:80466-0009
Mailing Address - Country:US
Mailing Address - Phone:303-258-3206
Mailing Address - Fax:303-258-7302
Practice Address - Street 1:20 E. LAKEVIEW DR.
Practice Address - Street 2:SUITE 205
Practice Address - City:NEDERLAND
Practice Address - State:CO
Practice Address - Zip Code:80466-0009
Practice Address - Country:US
Practice Address - Phone:303-258-3206
Practice Address - Fax:303-258-7302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0091261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05600812Medicaid
CO05600812Medicaid
COC12704Medicare PIN