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General NPI Number Information
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NPI Number | 1982893640
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Entity Type | Organization
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Legal Business Name | FAMILY MEDICAL CENTER LLC
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Dates
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Enumeration Date | 10/18/2007
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Last Update Date | 03/14/2008
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Provider Practice Location Address
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Address Line | 517 COLORADO AVE
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City | PUEBLO
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State | CO
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Zip | 81004-2075
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Country | US
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Telephone | 719-543-4016
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Fax | 719-542-6884
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Provider Business Mailing Address
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Address Line | 517 COLORADO AVE
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City | PUEBLO
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State | CO
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Zip | 81004-2075
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Country | US
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Telephone | 719-543-4016
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Fax | 719-542-6884
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHRISTOPHER JOHN SMITH
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Credential | M.D.
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Telephone | 719-543-4016
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 21599
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License Number State | CO
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