MEDICARE: FAMILY HEALTH CARE OF THE ROCKIES

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

General Provider Information

NPI Number	:	1336166420
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY HEALTH CARE OF THE ROCKIES

Provider Business Mailing Address
First Line	:	3000 S COLLEGE AVE
Second Line	:	STE 210
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-2558
Country	:	US
Telephone Number	:	970-266-8822
Fax Number	:	970-266-8833

Provider Business Practice Location Address
First Line	:	3000 S COLLEGE AVE
Second Line	:	STE 210
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-2558
Country	:	US
Telephone Number	:	970-266-8822
Fax Number	:	970-266-8833

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DAVE FERGUSON
Credential	:	MD
Telephone Number	:	970-266-8822

Provider Enumeration Date	:	07/16/2006
Last Update Date	:	02/07/2008

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