Provider Demographics
NPI:1770885667
Name:ASPEN CREEK FAMILY PRACTICE, P.C.
Entity type:Organization
Organization Name:ASPEN CREEK FAMILY PRACTICE, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:ELDER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:303-840-3800
Mailing Address - Street 1:19641 E PARKER SQUARE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-7399
Mailing Address - Country:US
Mailing Address - Phone:303-840-3800
Mailing Address - Fax:303-840-8442
Practice Address - Street 1:19641 E PARKER SQUARE DR
Practice Address - Street 2:SUITE A
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-7399
Practice Address - Country:US
Practice Address - Phone:303-840-3800
Practice Address - Fax:303-840-8442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-27
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO32721207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01327212Medicaid
CO501348Medicare PIN
COF99874Medicare UPIN