Provider Demographics
NPI:1174114417
Name:MOUNTAIN FAMILY HEALTH CENTERS
Entity type:Organization
Organization Name:MOUNTAIN FAMILY HEALTH CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:SHIELA
Authorized Official - Middle Name:R
Authorized Official - Last Name:KENDALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-928-1635
Mailing Address - Street 1:2700 GILSTRAP CT STE 100
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601-8735
Mailing Address - Country:US
Mailing Address - Phone:970-945-2840
Mailing Address - Fax:
Practice Address - Street 1:600 SOUTHSIDE DR
Practice Address - Street 2:
Practice Address - City:BASALT
Practice Address - State:CO
Practice Address - Zip Code:81621-9131
Practice Address - Country:US
Practice Address - Phone:970-945-2840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOUNTAIN FAMILY HEALTH CENTERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-01-29
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)