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General NPI Number Information
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NPI Number | 1578862983
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Entity Type | Organization
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Legal Business Name | MOUNTAIN FAMILY HEALTH CENTERS
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Dates
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Enumeration Date | 03/24/2011
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Last Update Date | 04/01/2021
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Provider Practice Location Address
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Address Line | 195 W 14TH STE C
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City | RIFLE
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State | CO
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Zip | 81650-4717
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Country | US
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Telephone | 970-945-2840
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Fax | 970-945-2893
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Provider Business Mailing Address
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Address Line | 1905 BLAKE AVE SUITE 101
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City | GLENWOOD SPRINGS
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State | CO
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Zip | 81601-4700
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Country | US
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Telephone | 970-945-2840
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Fax | 970-945-2893
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Authorized Official
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Title or Position | CEO
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Name | MR. ROSS A BROOKS
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Credential |
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Telephone | 970-945-2840
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health 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 | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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