MEDICARE: ARKANSAS VALLEY FAMILY PRACTICE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	31834	CO
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1255763710
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARKANSAS VALLEY FAMILY PRACTICE LLC

Provider Business Mailing Address
First Line	:	2317 SAN JUAN AVE
Second Line	:
City	:	LA JUNTA
State	:	CO
Zip	:	81050-3340
Country	:	US
Telephone Number	:	719-383-2325
Fax Number	:	719-383-2327

Provider Business Practice Location Address
First Line	:	2317 SAN JUAN AVE
Second Line	:
City	:	LA JUNTA
State	:	CO
Zip	:	81050-3340
Country	:	US
Telephone Number	:	719-383-2325
Fax Number	:	719-383-2327

Authorized Official
Title or Position	:	OWNER/PROVIDER
Name	:	RICHARD KENT BOOK
Credential	:
Telephone Number	:	719-383-2325

Provider Enumeration Date	:	08/06/2013
Last Update Date	:	10/08/2020

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Directions to “ARKANSAS VALLEY FAMILY PRACTICE LLC ” Practice Location

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