Healthcare Provider Details

I. General information

NPI: 1235720582
Provider Name (Legal Business Name): MOUNTAIN FAMILY HEALTH CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2021
Last Update Date: 01/29/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 COTTONWOOD DR
BASALT CO
81621-8345
US

IV. Provider business mailing address

2700 GILSTRAP CT STE 100
GLENWOOD SPRINGS CO
81601-8735
US

V. Phone/Fax

Practice location:
  • Phone: 970-945-2840
  • Fax: 970-945-2893
Mailing address:
  • Phone: 970-945-2840
  • Fax: 970-945-2893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: ROSS BROOKS
Title or Position: CEO
Credential:
Phone: 970-928-1609