Provider Demographics
NPI:1487074795
Name:FAMILY PHYSICIANS AT HIGHLANDS RANCH
Entity type:Organization
Organization Name:FAMILY PHYSICIANS AT HIGHLANDS RANCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:MCLEAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-791-0301
Mailing Address - Street 1:7960 S UNIVERSITY BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122-3167
Mailing Address - Country:US
Mailing Address - Phone:303-791-0301
Mailing Address - Fax:303-791-8511
Practice Address - Street 1:7960 S UNIVERSITY BLVD STE 101
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80122-3167
Practice Address - Country:US
Practice Address - Phone:303-791-0301
Practice Address - Fax:303-791-8511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-25
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO36684302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
COB18226Medicare UPIN