Healthcare Provider Details

I. General information

NPI: 1942698071
Provider Name (Legal Business Name): FAMILY PHYSICIANS OF GREELEY, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2014
Last Update Date: 07/20/2023
Certification Date: 07/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

473 CASTLE PINES AVE SUITE 1
JOHNSTOWN CO
80534
US

IV. Provider business mailing address

6801 W. 20TH STREET SUITE 101
GREELEY CO
80634
US

V. Phone/Fax

Practice location:
  • Phone: 970-587-7881
  • Fax: 970-587-7738
Mailing address:
  • Phone: 970-378-8000
  • Fax: 970-378-8088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. KYLE JON LYNCH
Title or Position: PRACTICE ADMINISTRATOR AUTHORIZED O
Credential:
Phone: 970-378-8000