Healthcare Provider Details

I. General information

NPI: 1528275906
Provider Name (Legal Business Name): FRONT RANGE FAMILY MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 08/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3260 E WOODMEN RD SUITE 210
COLORADO SPRINGS CO
80920-3587
US

IV. Provider business mailing address

3260 E WOODMEN RD SUITE 210
COLORADO SPRINGS CO
80920-3587
US

V. Phone/Fax

Practice location:
  • Phone: 719-262-0852
  • Fax: 719-262-0853
Mailing address:
  • Phone: 719-262-0852
  • Fax: 719-262-0853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number40494
License Number StateCO

VIII. Authorized Official

Name: DR. BRAD J REEDY
Title or Position: OWNER
Credential: D.O.
Phone: 719-262-0852