Healthcare Provider Details

I. General information

NPI: 1275142390
Provider Name (Legal Business Name): ALLINFAMILYMED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2020
Last Update Date: 02/01/2022
Certification Date: 02/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7610 N UNION BLVD STE 140
COLORADO SPRINGS CO
80920-3894
US

IV. Provider business mailing address

7610 N UNION BLVD STE 140
COLORADO SPRINGS CO
80920-3894
US

V. Phone/Fax

Practice location:
  • Phone: 719-550-1172
  • Fax: 719-591-2864
Mailing address:
  • Phone: 719-550-1172
  • Fax: 719-591-2864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LISA LALLIER BLACKWELDER
Title or Position: FAMILY NURSE PRACTITIONER
Credential: APN
Phone: 903-641-2481