MEDICARE: FAMILY CARE MEDICAL CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	17154	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083859466
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY CARE MEDICAL CENTER, INC.

Provider Business Mailing Address
First Line	:	1340 LEYDEN ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80220-2805
Country	:	US
Telephone Number	:	303-320-8686
Fax Number	:	303-320-1828

Provider Business Practice Location Address
First Line	:	1340 LEYDEN ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80220-2805
Country	:	US
Telephone Number	:	303-320-8686
Fax Number	:	303-320-1828

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ARIS MICHAEL SOPHOCLES JR.
Credential	:	MD
Telephone Number	:	303-320-8686

Provider Enumeration Date	:	12/12/2008
Last Update Date	:	12/12/2008

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