Organization
FAMILY MEDICAL CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHRISTOPHER JOHN SMITH M.D. (OWNER)
(719) 543-4016
Entity
Organization
Contact information
Practice address
517 COLORADO AVE, PUEBLO, CO 81004-2075
(719) 543-4016
(719) 542-6884
Mailing address
517 COLORADO AVE, PUEBLO, CO 81004-2075
(719) 543-4016
(719) 542-6884
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
21599
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01215995
—
CO
01
—
361918
MEDICARE
CO
Enumeration date
10/18/2007
Last updated
03/14/2008
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