Healthcare Provider Details

I. General information

NPI: 1336242783
Provider Name (Legal Business Name): COLUMBINE FAMILY MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 11/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 HWY 72 W
NEDERLAND CO
80466
US

IV. Provider business mailing address

PO BOX 550
NEDERLAND CO
80466-0550
US

V. Phone/Fax

Practice location:
  • Phone: 303-258-9355
  • Fax: 303-258-9356
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SUSAN MORRISON
Title or Position: PARTNER/OWNER
Credential: D.O.
Phone: 33032589355