Provider Demographics
NPI:1699000851
Name:PRESTIGE FAMILY MEDICINE
Entity Type:Organization
Organization Name:PRESTIGE FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:COREY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCARTY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:720-985-6484
Mailing Address - Street 1:1726 PARKDALE CIR N
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:CO
Mailing Address - Zip Code:80516-2403
Mailing Address - Country:US
Mailing Address - Phone:720-985-6484
Mailing Address - Fax:
Practice Address - Street 1:3030 E 2ND AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-5130
Practice Address - Country:US
Practice Address - Phone:303-321-4700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-06
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty