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General NPI Number Information
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NPI Number | 1023773611
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Entity Type | Organization
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Legal Business Name | DESERT RIVER FAMILY MEDICINE, LLC
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Dates
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Enumeration Date | 11/08/2021
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Last Update Date | 05/07/2025
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Provider Practice Location Address
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Address Line | 1335 PHAY AVE STE A
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City | CANON CITY
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State | CO
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Zip | 81212-2349
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Country | US
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Telephone | 719-285-8890
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Fax |
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Provider Business Mailing Address
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Address Line | 1335 PHAY AVE STE A
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City | CANON CITY
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State | CO
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Zip | 81212-2349
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Country | US
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Telephone | 719-285-8890
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Fax |
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | TARA L ROBICHEAUX
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Credential |
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Telephone | 719-285-8890
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0050X
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Taxonomy Name | Non-Surgical Family Planning Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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