Provider Demographics
NPI:1972773232
Name:FAMILY CENTERED MEDICINE, INC
Entity Type:Organization
Organization Name:FAMILY CENTERED MEDICINE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:PRUTCH
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:303-504-0600
Mailing Address - Street 1:2121 S ONEIDA ST STE 248
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224-2551
Mailing Address - Country:US
Mailing Address - Phone:303-504-0600
Mailing Address - Fax:
Practice Address - Street 1:2121 S ONEIDA ST STE 248
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80224-2551
Practice Address - Country:US
Practice Address - Phone:303-504-0600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO15883825Medicaid
CO803593Medicare PIN
COQ53744Medicare UPIN