Provider Demographics
NPI:1184775959
Name:CLINICA CAMPESINA FAMILY HEALTH SERVICES
Entity type:Organization
Organization Name:CLINICA CAMPESINA FAMILY HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SIMON
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-665-3036
Mailing Address - Street 1:1735 S PUBLIC RD STE 203
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-7093
Mailing Address - Country:US
Mailing Address - Phone:303-665-3036
Mailing Address - Fax:
Practice Address - Street 1:1701 W 72ND AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80221-2721
Practice Address - Country:US
Practice Address - Phone:720-207-0150
Practice Address - Fax:303-650-2557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2019-01-30
Deactivation Date:2008-06-03
Deactivation Code:
Reactivation Date:2008-07-21
Provider Licenses
StateLicense IDTaxonomies
CO535261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health