MEDICARE: ELK RIDGE FAMILY PHYSICIANS INC

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	25525	CO

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	:	1609832120
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELK RIDGE FAMILY PHYSICIANS INC

Provider Business Mailing Address
First Line	:	30940 STAGECOACH BLVD
Second Line	:	SUITE E290
City	:	EVERGREEN
State	:	CO
Zip	:	80439-7984
Country	:	US
Telephone Number	:	303-674-8153
Fax Number	:	303-674-8303

Provider Business Practice Location Address
First Line	:	30940 STAGECOACH BLVD
Second Line	:	SUITE E290
City	:	EVERGREEN
State	:	CO
Zip	:	80439-7984
Country	:	US
Telephone Number	:	303-674-8153
Fax Number	:	303-674-8303

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. JULIE BROWN
Credential	:
Telephone Number	:	303-670-7021

Provider Enumeration Date	:	04/24/2006
Last Update Date	:	03/17/2008

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