Provider Demographics
NPI:1851362420
Name:GARRISON FAMILY PHYSICIANS PC
Entity Type:Organization
Organization Name:GARRISON FAMILY PHYSICIANS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:AMUNDSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-237-2779
Mailing Address - Street 1:205 S GARRISON ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-2843
Mailing Address - Country:US
Mailing Address - Phone:303-237-2779
Mailing Address - Fax:303-237-4428
Practice Address - Street 1:205 S GARRISON ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-2843
Practice Address - Country:US
Practice Address - Phone:303-237-2779
Practice Address - Fax:303-237-4428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-31
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04014379Medicaid
COCE5208Medicare PIN
0663600001Medicare NSC