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General NPI Number Information
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NPI Number | 1720301344
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Entity Type | Organization
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Legal Business Name | YOUR FAMILY MEDICAL HOME,PLLC
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Dates
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Enumeration Date | 03/10/2010
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Last Update Date | 08/17/2021
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Provider Practice Location Address
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Address Line | 435 N PARK AV SUITE 2A
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City | BRECKENRIDGE
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State | CO
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Zip | 80424
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Country | US
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Telephone | 970-238-7070
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Fax | 970-453-5332
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Provider Business Mailing Address
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Address Line | PO BOX 5620
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City | BRECKENRIDGE
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State | CO
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Zip | 80424-5620
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Country | US
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Telephone | 970-238-7070
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Fax | 970-423-5332
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JOHN DAVID ZAITZ
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Credential |
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Telephone | 925-597-0121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | 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 | 31975
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License Number State | CO
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