Provider Demographics
NPI:1841325222
Name:AURORA FAMILY PRACTICE GROUP PC
Entity type:Organization
Organization Name:AURORA FAMILY PRACTICE GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-369-1080
Mailing Address - Street 1:1550 S POTOMAC ST
Mailing Address - Street 2:SUITE 370
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-5455
Mailing Address - Country:US
Mailing Address - Phone:303-369-1080
Mailing Address - Fax:303-750-4913
Practice Address - Street 1:1550 S POTOMAC ST
Practice Address - Street 2:SUITE 370
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-5455
Practice Address - Country:US
Practice Address - Phone:303-369-1080
Practice Address - Fax:303-750-4913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11245207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COAU71504OtherANTHEM BL CROSS BL SHIELD
COAU71504OtherANTHEM BL CROSS BL SHIELD