MEDICARE: ALAMEDA PRIMARY CARE CLINIC

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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1629449087
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALAMEDA PRIMARY CARE CLINIC

Provider Business Mailing Address
First Line	:	2370 W ALAMEDA AVE UNIT 5
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80223-1991
Country	:	US
Telephone Number	:	303-936-5337
Fax Number	:

Provider Business Practice Location Address
First Line	:	2370 W ALAMEDA AVE UNIT 5
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80223-1991
Country	:	US
Telephone Number	:	303-936-5337
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	GEORGE SACKEY
Credential	:	RPH
Telephone Number	:	303-668-0032

Provider Enumeration Date	:	10/12/2015
Last Update Date	:	10/23/2015

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