# LONGS PEAK FAMILY PRACTICE, PC

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

## Provider details

- **NPI number:** 1477565380
- **Authorized official:** DR. SUSAN I ROACH M.D. (OFFICER)
- **Authorized official phone:** (303) 772-5578

## Contact information

- **Practice address:** 1309 SUNSET ST, LONGMONT, CO 80501-3215
- **Practice address phone:** (303) 772-5578
- **Practice address fax:** (303) 772-8207
- **Mailing address:** 1309 SUNSET ST, LONGMONT, CO 80501-3215
- **Mailing address phone:** (303) 772-5578
- **Mailing address fax:** (303) 772-8207

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | — | NULL | — |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | — | — | — |

## Other

- **Enumeration date:** 08/12/2006
- **Last updated:** 02/08/2008