Provider Demographics
NPI:1639100365
Name:WOODRIDGE FAMILY PHYSICIANS, P.C.
Entity Type:Organization
Organization Name:WOODRIDGE FAMILY PHYSICIANS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:D
Authorized Official - Last Name:SPAZIANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-232-4490
Mailing Address - Street 1:2020 WADSWORTH BLVD STE 8
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80214-5730
Mailing Address - Country:US
Mailing Address - Phone:303-232-4490
Mailing Address - Fax:303-239-6098
Practice Address - Street 1:2020 WADSWORTH BLVD STE 8
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80214-5730
Practice Address - Country:US
Practice Address - Phone:303-232-4490
Practice Address - Fax:303-239-6098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO23262174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04023750Medicaid
CO04023750Medicaid
CO5228-1Medicare ID - Type Unspecified
COI22886Medicare UPIN