Provider Demographics
NPI:1023127859
Name:ASPEN FAMILY MEDICAL
Entity type:Organization
Organization Name:ASPEN FAMILY MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:LYONS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-882-1300
Mailing Address - Street 1:2874 N CARSON ST STE 127
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89706-1681
Mailing Address - Country:US
Mailing Address - Phone:775-882-1300
Mailing Address - Fax:775-882-1332
Practice Address - Street 1:2874 N CARSON ST STE 127
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89706-1681
Practice Address - Country:US
Practice Address - Phone:775-882-1300
Practice Address - Fax:775-882-1332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVDA3942OtherRAILROAD MEDICARE
NVV37302Medicare ID - Type Unspecified