# PREMIER RURAL FAMILY MEDICAL & DENTAL CARE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417444043
- **Authorized official:** WILLIAM J ROBERS (ATTORNEY)
- **Authorized official phone:** (719) 634-5700

## Contact information

- **Practice address:** 1101 TELLER COUNTY ROAD 1, CRIPPLE CREEK, CO 80813
- **Practice address phone:** (419) 508-7686
- **Mailing address:** 24 S WEBER ST STE 400, COLORADO SPRINGS, CO 80903-1928
- **Mailing address phone:** (719) 634-5700
- **Mailing address fax:** (719) 633-8477

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | NULL | — |
| 122300000X | Dentist | — | — | — |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/19/2018
- **Last updated:** 04/19/2018