Provider Demographics
NPI:1952593873
Name:FAMILY PRACTICE ASSOCIATES PC
Entity Type:Organization
Organization Name:FAMILY PRACTICE ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-673-9090
Mailing Address - Street 1:433 SUMMIT BLVD UNIT 201
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021-8299
Mailing Address - Country:US
Mailing Address - Phone:303-673-9090
Mailing Address - Fax:303-673-9195
Practice Address - Street 1:433 SUMMIT BLVD UNIT 201
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80021-8299
Practice Address - Country:US
Practice Address - Phone:303-673-9090
Practice Address - Fax:303-673-9195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-14
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO49958372Medicaid
COC359508Medicare PIN