Provider Demographics
NPI:1801198270
Name:COLUMBINE FAMILY CARE PC
Entity type:Organization
Organization Name:COLUMBINE FAMILY CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:CAMARATA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-258-9355
Mailing Address - Street 1:PO BOX 127
Mailing Address - Street 2:
Mailing Address - City:NEDERLAND
Mailing Address - State:CO
Mailing Address - Zip Code:80466-0127
Mailing Address - Country:US
Mailing Address - Phone:303-258-9355
Mailing Address - Fax:303-258-3382
Practice Address - Street 1:20 LAKEVIEW DRIVE
Practice Address - Street 2:SUITE 204
Practice Address - City:NEDERLAND
Practice Address - State:CO
Practice Address - Zip Code:80466
Practice Address - Country:US
Practice Address - Phone:303-258-9355
Practice Address - Fax:303-258-3382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-17
Last Update Date:2017-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO37684207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO79400566Medicaid