Healthcare Provider Details

I. General information

NPI: 1275578247
Provider Name (Legal Business Name): FAMILY MEDICINE CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 03/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6179 S BALSAM WAY SUITE 110
LITTLETON CO
80123-3091
US

IV. Provider business mailing address

6179 S. BALSAM WAY SUITE 110
LITTLETON CO
80123-3092
US

V. Phone/Fax

Practice location:
  • Phone: 303-948-1570
  • Fax: 303-972-6871
Mailing address:
  • Phone: 303-948-1570
  • Fax: 303-972-6871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2274844
License Number StateCO

VIII. Authorized Official

Name: MRS. JACKIE L KARSTEN
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 303-972-6992