MEDICARE: WELLSPRING FAMILY HEALTH CARE

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	CO42177	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	:	1740454909
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLSPRING FAMILY HEALTH CARE

Provider Business Mailing Address
First Line	:	1136 E STUART ST STE 3240
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-1196
Country	:	US
Telephone Number	:	970-224-0754
Fax Number	:	970-224-0757

Provider Business Practice Location Address
First Line	:	1136 E STUART ST STE 3240
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-1196
Country	:	US
Telephone Number	:	970-224-0754
Fax Number	:	970-224-0757

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. FLORA BREWINGTON
Credential	:	M.D.
Telephone Number	:	970-224-0754

Provider Enumeration Date	:	04/18/2008
Last Update Date	:	04/18/2008

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Directions to “WELLSPRING FAMILY HEALTH CARE ” Practice Location

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