Healthcare Provider Details

I. General information

NPI: 1467451336
Provider Name (Legal Business Name): MOUNTAIN FAMILY HEALTH CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

562 GREGORY ST
BLACK HAWK CO
80422-0066
US

IV. Provider business mailing address

PO BOX 66
BLACK HAWK CO
80422-0066
US

V. Phone/Fax

Practice location:
  • Phone: 303-582-5276
  • Fax: 303-582-3929
Mailing address:
  • Phone: 303-582-5276
  • Fax: 303-582-3929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number30655
License Number StateCO

VIII. Authorized Official

Name: DR. LEE ELMA HOWELL JR.
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 303-582-5276