Provider Demographics
NPI:1750578423
Name:SOUTH SUBURBAN FAMILY PRACTICE P C
Entity type:Organization
Organization Name:SOUTH SUBURBAN FAMILY PRACTICE P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:VERKLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-721-0220
Mailing Address - Street 1:7180 E ORCHARD RD STE 101
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80111-1725
Mailing Address - Country:US
Mailing Address - Phone:303-721-0220
Mailing Address - Fax:303-771-8560
Practice Address - Street 1:7180 E ORCHARD RD STE 101
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80111-1725
Practice Address - Country:US
Practice Address - Phone:303-721-0220
Practice Address - Fax:303-771-8560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO26985207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1366447484OtherPROVIDER NPI
CODN8671Medicare PIN
CO080103699Medicare PIN
COC46004Medicare PIN