Organization
POTOMAC SQUARE FAMILY MEDICINE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE GLUCHACKI (SVP, COMPLIANCE)
(508) 689-9706
Entity
Organization
Contact information
Practice address
13650 E MISSISSIPPI AVE STE 110, AURORA, CO 80012-3573
(303) 695-8684
(303) 597-0191
Mailing address
PO BOX 173848, DENVER, CO 80217-3848
(303) 945-3299
(303) 341-4708
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
77404343
—
CO
Enumeration date
05/23/2006
Last updated
04/15/2022
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