Basic Information
| Provider Information | |||||||||
| NPI: | 1518412253 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASSOCIATES IN FAMILY MEDICINE, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2001 S SHIELDS ST | ||||||||
| Address2: | BUILDING I | ||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805261827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702215255 | ||||||||
| FaxNumber: | 9702215206 | ||||||||
| Practice Location | |||||||||
| Address1: | 2001 S SHIELDS ST BLDG I | ||||||||
| Address2: | |||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805261827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702215255 | ||||||||
| FaxNumber: | 9702215206 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2016 | ||||||||
| LastUpdateDate: | 09/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MOSNESS | ||||||||
| AuthorizedOfficialFirstName: | HELEN | ||||||||
| AuthorizedOfficialMiddleName: | JEAN | ||||||||
| AuthorizedOfficialTitleorPosition: | CREDENTIALING/PHYSICIAN SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 9704956291 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | N | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 261QP2300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
ID Information
| ID | Type | State | Issuer | Description | 83524762 | 05 | CO | MEDICAID |