Provider Demographics
NPI:1700229143
Name:LONGMONT INTEGRATIVE FAMILY PRACTICE PLLC
Entity Type:Organization
Organization Name:LONGMONT INTEGRATIVE FAMILY PRACTICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:303-776-8847
Mailing Address - Street 1:2130 MOUNTAIN VIEW AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-3177
Mailing Address - Country:US
Mailing Address - Phone:303-776-8847
Mailing Address - Fax:303-776-8897
Practice Address - Street 1:2130 MOUNTAIN VIEW AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-3177
Practice Address - Country:US
Practice Address - Phone:303-776-8847
Practice Address - Fax:303-776-8897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO50861207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty