Basic Information
| Provider Information | |||||||||
| NPI: | 1639533656 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FAMILY MEDICINE ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1022 DEPOT HILL RD | ||||||||
| Address2: | |||||||||
| City: | BROOMFIELD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800201068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034652323 | ||||||||
| FaxNumber: | 3034651260 | ||||||||
| Practice Location | |||||||||
| Address1: | 1022 DEPOT HILL RD | ||||||||
| Address2: | |||||||||
| City: | BROOMFIELD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800201068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034652323 | ||||||||
| FaxNumber: | 3034651260 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2016 | ||||||||
| LastUpdateDate: | 04/06/2016 | ||||||||
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| AuthorizedOfficialLastName: | KANDEL | ||||||||
| AuthorizedOfficialFirstName: | ELISABETH | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3034652323 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA.0004585 | CO | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.