Basic Information
| Provider Information | |||||||||
| NPI: | 1043584253 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FRONT RANGE PRIMARY CARE PARTNERS LLC | ||||||||
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| OtherOrganizationName: | MT. CARMEL HEALTH & WELLNESS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6895 E HAMPDEN AVE | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802243047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3038949595 | ||||||||
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| Practice Location | |||||||||
| Address1: | 911 ROBINSON AVE | ||||||||
| Address2: | |||||||||
| City: | TRINIDAD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 810822832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7198454880 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2012 | ||||||||
| LastUpdateDate: | 04/11/2012 | ||||||||
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| AuthorizedOfficialLastName: | REHM | ||||||||
| AuthorizedOfficialFirstName: | CHRISTOPHER | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 3034070525 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | FRONT RANGE PRIMARY CARE PARTNERS LLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.