Basic Information
| Provider Information | |||||||||
| NPI: | 1952593873 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FAMILY PRACTICE ASSOCIATES PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 433 SUMMIT BLVD UNIT 201 | ||||||||
| Address2: | |||||||||
| City: | BROOMFIELD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800218299 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036739090 | ||||||||
| FaxNumber: | 3036739195 | ||||||||
| Practice Location | |||||||||
| Address1: | 433 SUMMIT BLVD UNIT 201 | ||||||||
| Address2: | |||||||||
| City: | BROOMFIELD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800218299 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036739090 | ||||||||
| FaxNumber: | 3036739195 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2007 | ||||||||
| LastUpdateDate: | 03/06/2020 | ||||||||
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| AuthorizedOfficialLastName: | MARTIN | ||||||||
| AuthorizedOfficialFirstName: | ANGIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3036739090 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 49958372 | 05 | CO | MEDICAID |