Provider Demographics
NPI:1679625735
Name:SWEDISH FAMILY MEDICINE PROVIDERS, PC
Entity Type:Organization
Organization Name:SWEDISH FAMILY MEDICINE PROVIDERS, PC
Other - Org Name:SWEDISH FAMILY MEDICINE RESIDENCY
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADFORD
Authorized Official - Middle Name:
Authorized Official - Last Name:WINSLOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-788-3150
Mailing Address - Street 1:191 E ORCHARD RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80121-8000
Mailing Address - Country:US
Mailing Address - Phone:303-788-3150
Mailing Address - Fax:303-788-3199
Practice Address - Street 1:191 E ORCHARD RD
Practice Address - Street 2:SUITE 200
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80121-8000
Practice Address - Country:US
Practice Address - Phone:303-788-3150
Practice Address - Fax:303-788-3199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCG3836OtherRAILROAD MEDICARE
COCG3836OtherRAILROAD MEDICARE