Healthcare Provider Details

I. General information

NPI: 1811279136
Provider Name (Legal Business Name): CLINICA CAMPESINA FAMILY HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2011
Last Update Date: 02/24/2022
Certification Date: 02/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8510 BRYANT ST FL 2
WESTMINSTER CO
80031-3844
US

IV. Provider business mailing address

1735 S PUBLIC RD
LAFAYETTE CO
80026-7093
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BRIAN J JOHNSTON
Title or Position: CFO
Credential:
Phone: 303-926-0625