Healthcare Provider Details

I. General information

NPI: 1548256522
Provider Name (Legal Business Name): CLINICA CAMPESINA FAMILY HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 01/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 W 72ND AVE
DENVER CO
80221-2721
US

IV. Provider business mailing address

1735 S PUBLIC RD STE 203
LAFAYETTE CO
80026-7093
US

V. Phone/Fax

Practice location:
  • Phone: 303-650-4460
  • Fax: 303-650-6830
Mailing address:
  • Phone: 303-665-3036
  • Fax: 303-665-9566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number0556
License Number StateCO

VIII. Authorized Official

Name: SIMON SMITH
Title or Position: CEO
Credential:
Phone: 303-665-3036