Provider Demographics
NPI:1780735431
Name:RED FEATHER MEDICAL CLINIC LLC
Entity type:Organization
Organization Name:RED FEATHER MEDICAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WEIXELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:970-881-2885
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:
Mailing Address - City:RED FEATHER LAKES
Mailing Address - State:CO
Mailing Address - Zip Code:80545-0547
Mailing Address - Country:US
Mailing Address - Phone:970-881-2885
Mailing Address - Fax:970-881-3440
Practice Address - Street 1:168 MAIN STREET
Practice Address - Street 2:
Practice Address - City:RED FEATHER LAKES
Practice Address - State:CO
Practice Address - Zip Code:80545-0545
Practice Address - Country:US
Practice Address - Phone:970-881-2885
Practice Address - Fax:970-881-3440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO40384207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC525588Medicare PIN