Basic Information
| Provider Information | |||||||||
| NPI: | 1720084635 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHWEST FAMILY MEDICINE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 DISCOVERY PKWY | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | SUPERIOR | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800278639 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034259581 | ||||||||
| FaxNumber: | 3034259259 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 DISCOVERY PKWY | ||||||||
| Address2: | STE 150 | ||||||||
| City: | SUPERIOR | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800278639 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034259581 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2005 | ||||||||
| LastUpdateDate: | 01/07/2008 | ||||||||
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| AuthorizedOfficialLastName: | DETWILER | ||||||||
| AuthorizedOfficialFirstName: | DEVIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRACTICE ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 3034259581 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | 105493 | CO | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.