Provider Demographics
NPI:1720301344
Name:YOUR FAMILY MEDICAL HOME,PLLC
Entity Type:Organization
Organization Name:YOUR FAMILY MEDICAL HOME,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:ZAITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-597-0121
Mailing Address - Street 1:PO BOX 5620
Mailing Address - Street 2:
Mailing Address - City:BRECKENRIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80424-5620
Mailing Address - Country:US
Mailing Address - Phone:970-238-7070
Mailing Address - Fax:970-423-5332
Practice Address - Street 1:435 N PARK AV
Practice Address - Street 2:SUITE 2A
Practice Address - City:BRECKENRIDGE
Practice Address - State:CO
Practice Address - Zip Code:80424
Practice Address - Country:US
Practice Address - Phone:970-238-7070
Practice Address - Fax:970-453-5332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-10
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO31975207Q00000X
261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01319755Medicaid
CO81751737Medicaid