MEDICARE: FAMILY MEDICAL PC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	FAU3608	OTHER	CO	BLUE CROSS

General Provider Information

NPI Number	:	1326085697
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY MEDICAL PC

Provider Business Mailing Address
First Line	:	3198 F RD STE 103
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81504-4039
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3198 F RD STE 103
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81504-4039
Country	:	US
Telephone Number	:	970-434-4891
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	DEBBIE JOHNS
Credential	:
Telephone Number	:	970-254-1686

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	08/07/2008

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Directions to “FAMILY MEDICAL PC ” Practice Location

Language	Start Address	Practice Location

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