Organization Name: | WHEAT RIDGE FAMILY CLINIC PC |
NPI Number: | 1013070051 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MAURICE A ARCHULETA (OWNER PRESIDENT) |
Mailing Address: | 6301 W 38th Ave Wheat Ridge |
State: | CO US |
Postal Code: | 800335057 |
Phone Number: | 3039409118 |
Fax Number: | 3039405943 |
NPI Enumeration Date: | 12/19/2006 |
NPI Last Update Date: | 03/18/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | 27027 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CO |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |