Provider Demographics
NPI:1679604748
Name:FRONT RANGE MEDICAL ARTS, P.C.
Entity Type:Organization
Organization Name:FRONT RANGE MEDICAL ARTS, P.C.
Other - Org Name:JOHN KURISH, DOPC
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARYANN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-599-0444
Mailing Address - Street 1:5265 N ACADEMY BLVD
Mailing Address - Street 2:SUITE 1800
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-4060
Mailing Address - Country:US
Mailing Address - Phone:719-599-0444
Mailing Address - Fax:719-599-8809
Practice Address - Street 1:5265 N ACADEMY BLVD
Practice Address - Street 2:SUITE 1800
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-4060
Practice Address - Country:US
Practice Address - Phone:719-599-0444
Practice Address - Fax:719-599-8809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC312408Medicare PIN