Provider Demographics
NPI:1851935753
Name:COMFORT CARE FAMILY PRACTICE, INC.
Entity Type:Organization
Organization Name:COMFORT CARE FAMILY PRACTICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:WIESCAMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-510-0957
Mailing Address - Street 1:5799 STETSON HILLS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-4223
Mailing Address - Country:US
Mailing Address - Phone:719-471-2273
Mailing Address - Fax:719-325-8971
Practice Address - Street 1:6530 S ACADEMY BLVD STE 105
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-8635
Practice Address - Country:US
Practice Address - Phone:719-471-2273
Practice Address - Fax:719-325-8971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-04
Last Update Date:2024-02-15
Deactivation Date:2024-01-25
Deactivation Code:
Reactivation Date:2024-02-14
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO38904284Medicaid