Provider Demographics
NPI:1457534232
Name:GREENWOOD VILLAGE FAMILY MEDICINE PC
Entity Type:Organization
Organization Name:GREENWOOD VILLAGE FAMILY MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERESE
Authorized Official - Middle Name:E
Authorized Official - Last Name:DONCH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:303-221-5700
Mailing Address - Street 1:8200 E BELLEVIEW AVE
Mailing Address - Street 2:STE 204C
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2888
Mailing Address - Country:US
Mailing Address - Phone:303-221-5700
Mailing Address - Fax:
Practice Address - Street 1:8200 E BELLEVIEW AVE STE 204C
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2805
Practice Address - Country:US
Practice Address - Phone:303-221-5700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-14
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO36427207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC485808OtherPROVIDER/GROUP
COH54921Medicare UPIN