Provider Demographics
NPI:1710997754
Name:BELMAR FAMILY MEDICINE PC
Entity Type:Organization
Organization Name:BELMAR FAMILY MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:S
Authorized Official - Last Name:HOFEDITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-232-8383
Mailing Address - Street 1:325 S TELLER ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226
Mailing Address - Country:US
Mailing Address - Phone:303-232-8383
Mailing Address - Fax:303-232-8207
Practice Address - Street 1:325 S TELLER ST
Practice Address - Street 2:SUITE 250
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226
Practice Address - Country:US
Practice Address - Phone:303-232-8383
Practice Address - Fax:303-232-8207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO29068207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC808884OtherMEDICARE PTAN
COC808884OtherMEDICARE PTAN