Provider Demographics
NPI:1972778363
Name:CONIFER INTEGRATIVE FAMILY MEDICINE LLC
Entity Type:Organization
Organization Name:CONIFER INTEGRATIVE FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OM
Authorized Official - Prefix:
Authorized Official - First Name:JENIFFER
Authorized Official - Middle Name:
Authorized Official - Last Name:VIGIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-838-5880
Mailing Address - Street 1:11873 SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:CONIFER
Mailing Address - State:CO
Mailing Address - Zip Code:80433-7263
Mailing Address - Country:US
Mailing Address - Phone:303-838-5880
Mailing Address - Fax:
Practice Address - Street 1:11873 SPRINGS RD
Practice Address - Street 2:
Practice Address - City:CONIFER
Practice Address - State:CO
Practice Address - Zip Code:80433-7263
Practice Address - Country:US
Practice Address - Phone:303-838-5880
Practice Address - Fax:303-838-6006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO33276261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
F96944Medicare UPIN