Provider Demographics
NPI:1942404777
Name:ELIZABETH FAMILY HEALTH PC
Entity Type:Organization
Organization Name:ELIZABETH FAMILY HEALTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:REBEKAH
Authorized Official - Middle Name:
Authorized Official - Last Name:LIPKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-646-5820
Mailing Address - Street 1:PO BOX 1272
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:CO
Mailing Address - Zip Code:80107-1272
Mailing Address - Country:US
Mailing Address - Phone:303-646-4071
Mailing Address - Fax:
Practice Address - Street 1:34061 FOREST PARK DR
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:CO
Practice Address - Zip Code:80107-7842
Practice Address - Country:US
Practice Address - Phone:303-646-4071
Practice Address - Fax:303-646-0908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO99904Medicare PIN
CO99904Medicare UPIN