MEDICARE: MOUNTAIN FAMILY HEALTH CENTERS

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	261QC1500X	Community Health Clinic/Center
2	261QF0400X	Federally Qualified Health Center (FQHC)

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

General Provider Information

NPI Number	:	1477552388
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNTAIN FAMILY HEALTH CENTERS

Provider Business Mailing Address
First Line	:	2700 GILSTRAP CT STE 230
Second Line	:
City	:	GLENWOOD SPRINGS
State	:	CO
Zip	:	81601-8735
Country	:	US
Telephone Number	:	970-945-2840
Fax Number	:	970-945-2893

Provider Business Practice Location Address
First Line	:	1905 BLAKE AVE
Second Line	:	SUITE 101
City	:	GLENWOOD SPRINGS
State	:	CO
Zip	:	81601-4288
Country	:	US
Telephone Number	:	970-945-2840
Fax Number	:	970-945-2893

Authorized Official
Title or Position	:	CEO
Name	:	MR. DUSTIN MOYER
Credential	:
Telephone Number	:	970-945-2840

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	06/24/2024

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Directions to “MOUNTAIN FAMILY HEALTH CENTERS ” Practice Location

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