| Organization Name: | FAMILY MEDICINE CLINIC |
| NPI Number: | 1760675698 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | C DAVID NEECE (OWNER/PROVIDER) |
| Mailing Address: | 100 W 4th St Walsenburg |
| State: | CO US |
| Postal Code: | 810891910 |
| Phone Number: | 7197381164 |
| Fax Number: | 7197383399 |
| NPI Enumeration Date: | 08/23/2007 |
| NPI Last Update Date: | 05/04/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 27053 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CO |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |