Provider Demographics
NPI:1477041655
Name:FHC,MD, P.C.
Entity type:Organization
Organization Name:FHC,MD, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:HOSUK
Authorized Official - Last Name:CHAE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-662-1191
Mailing Address - Street 1:10099 RIDGEGATE PKWY STE 390
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-5535
Mailing Address - Country:US
Mailing Address - Phone:303-662-1191
Mailing Address - Fax:303-662-1343
Practice Address - Street 1:10099 RIDGEGATE PKWY STE 390
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5535
Practice Address - Country:US
Practice Address - Phone:303-662-1191
Practice Address - Fax:303-662-1343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-24
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO36200208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01362003Medicaid