Provider Demographics
NPI:1609832120
Name:ELK RIDGE FAMILY PHYSICIANS INC
Entity Type:Organization
Organization Name:ELK RIDGE FAMILY PHYSICIANS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-670-7021
Mailing Address - Street 1:30940 STAGECOACH BLVD
Mailing Address - Street 2:SUITE E290
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-7984
Mailing Address - Country:US
Mailing Address - Phone:303-674-8153
Mailing Address - Fax:303-674-8303
Practice Address - Street 1:30940 STAGECOACH BLVD
Practice Address - Street 2:SUITE E290
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-7984
Practice Address - Country:US
Practice Address - Phone:303-674-8153
Practice Address - Fax:303-674-8303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-24
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO25525207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04017109Medicaid
COC524128Medicare PIN
CO0982500001Medicare NSC