MEDICARE: CLINICA CAMPESINA FAMILY HEALTH SERVICES

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center
2	261QF0400X	Federally Qualified Health Center (FQHC)
3	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1538057815
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINICA CAMPESINA FAMILY HEALTH SERVICES

Provider Business Mailing Address
First Line	:	1455 DIXON AVE
Second Line	:
City	:	LAFAYETTE
State	:	CO
Zip	:	80026-8879
Country	:	US
Telephone Number	:	303-443-8500
Fax Number	:	720-687-2752

Provider Business Practice Location Address
First Line	:	975 NORTH ST
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80304-3406
Country	:	US
Telephone Number	:	303-443-8500
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	BRIAN J JOHNSTON
Credential	:
Telephone Number	:	303-926-0625

Provider Enumeration Date	:	06/25/2025
Last Update Date	:	09/16/2025

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