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	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)	0556	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	:	1831186915
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINICA CAMPESINA FAMILY HEALTH SERVICES

Provider Business Mailing Address
First Line	:	1735 S PUBLIC RD STE 203
Second Line	:
City	:	LAFAYETTE
State	:	CO
Zip	:	80026-7093
Country	:	US
Telephone Number	:	303-665-3036
Fax Number	:	303-665-9566

Provider Business Practice Location Address
First Line	:	1735 S PUBLIC RD STE 100
Second Line	:
City	:	LAFAYETTE
State	:	CO
Zip	:	80026-7093
Country	:	US
Telephone Number	:	303-665-9310
Fax Number	:	303-926-0363

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

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	10/31/2024

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