Provider Demographics
NPI:1619160033
Name:WINDSOR FAMILY CLINIC, PC
Entity Type:Organization
Organization Name:WINDSOR FAMILY CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:NOETZELMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-515-6352
Mailing Address - Street 1:4630 ROYAL VISTA CIR STE 7
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80528-9371
Mailing Address - Country:US
Mailing Address - Phone:970-530-0575
Mailing Address - Fax:970-530-0581
Practice Address - Street 1:4630 ROYAL VISTA CIR STE 7
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80528-9371
Practice Address - Country:US
Practice Address - Phone:970-530-0575
Practice Address - Fax:970-530-0581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04008595Medicaid
COCR4608Medicare UPIN