Provider Demographics
NPI:1669652814
Name:BRUNDIGE FAMILY PRACTICE, P.C.
Entity type:Organization
Organization Name:BRUNDIGE FAMILY PRACTICE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:QUIST
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:303-237-0086
Mailing Address - Street 1:8015 W ALAMEDA AVE
Mailing Address - Street 2:SUITE 050
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-3041
Mailing Address - Country:US
Mailing Address - Phone:303-237-0086
Mailing Address - Fax:303-237-6112
Practice Address - Street 1:8015 W ALAMEDA AVE
Practice Address - Street 2:SUITE 050
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-3041
Practice Address - Country:US
Practice Address - Phone:303-237-0086
Practice Address - Fax:303-237-6112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO19240207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO79204OtherBLUE CROSS/BLUE SHIELD
COD23564Medicare UPIN
C79204Medicare PIN