Provider Demographics
NPI:1720273717
Name:FAMILY CARE SOUTHWEST, P.C.
Entity Type:Organization
Organization Name:FAMILY CARE SOUTHWEST, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:MILLS
Authorized Official - Last Name:KILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-933-8886
Mailing Address - Street 1:6169 S BALSAM WAY
Mailing Address - Street 2:SUITE 250
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-3062
Mailing Address - Country:US
Mailing Address - Phone:303-933-8886
Mailing Address - Fax:303-933-8147
Practice Address - Street 1:6169 S BALSAM WAY
Practice Address - Street 2:SUITE 250
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-3062
Practice Address - Country:US
Practice Address - Phone:303-933-8886
Practice Address - Fax:303-933-8147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC392806Medicare PIN