Provider Demographics
NPI:1760541452
Name:FAMILY MEDICAL SERVICES
Entity Type:Organization
Organization Name:FAMILY MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:T
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-456-1340
Mailing Address - Street 1:810 THIRD STREET
Mailing Address - Street 2:
Mailing Address - City:LAS ANIMAS
Mailing Address - State:CO
Mailing Address - Zip Code:81054
Mailing Address - Country:US
Mailing Address - Phone:719-456-1340
Mailing Address - Fax:719-456-3131
Practice Address - Street 1:810 THIRD STREET
Practice Address - Street 2:
Practice Address - City:LAS ANIMAS
Practice Address - State:CO
Practice Address - Zip Code:81054
Practice Address - Country:US
Practice Address - Phone:719-456-1340
Practice Address - Fax:719-456-3131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC800941Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER