MEDICARE: CONIFER INTEGRATIVE FAMILY MEDICINE LLC

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	261QP2300X	Primary Care Clinic/Center	33276	CO

General Provider Information

NPI Number	:	1972778363
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONIFER INTEGRATIVE FAMILY MEDICINE LLC

Provider Business Mailing Address
First Line	:	11873 SPRINGS RD
Second Line	:
City	:	CONIFER
State	:	CO
Zip	:	80433-7263
Country	:	US
Telephone Number	:	303-838-5880
Fax Number	:

Provider Business Practice Location Address
First Line	:	11873 SPRINGS RD
Second Line	:
City	:	CONIFER
State	:	CO
Zip	:	80433-7263
Country	:	US
Telephone Number	:	303-838-5880
Fax Number	:	303-838-6006

Authorized Official
Title or Position	:	OM
Name	:	JENIFFER VIGIL
Credential	:
Telephone Number	:	303-838-5880

Provider Enumeration Date	:	04/25/2008
Last Update Date	:	04/25/2008

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