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General NPI Number Information
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NPI Number | 1417402918
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Entity Type | Organization
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Legal Business Name | EAST WEST FAMILY HEALTH LLC
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Dates
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Enumeration Date | 08/25/2016
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Last Update Date | 05/29/2019
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Provider Practice Location Address
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Address Line | 8200 E. BELLEVIEW AVENUE SUITE 203-C
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City | GREENWOOD VILLAGE
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State | CO
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Zip | 80111-2835
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Country | US
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Telephone | 303-221-6797
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Fax | 303-221-4563
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Provider Business Mailing Address
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Address Line | 8200 E. BELLEVIEW AVENUE SUITE 203-C
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City | GREENWOOD VILLAGE
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State | CO
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Zip | 80111-2835
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Country | US
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Telephone | 303-221-6797
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Fax | 303-221-4563
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | MR. FLOYD B RUSSAK
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Credential | M.D.
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Telephone | 303-591-8161
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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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 | 35559
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License Number State | CO
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