Provider Demographics
NPI:1073831103
Name:FAMILY INTEGRATIVE HEALTH CENTER OF COLORADO SPRINGS LLC
Entity type:Organization
Organization Name:FAMILY INTEGRATIVE HEALTH CENTER OF COLORADO SPRINGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:BRIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:719-599-5668
Mailing Address - Street 1:2850 W. SERENDIPITY CIRCLE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917
Mailing Address - Country:US
Mailing Address - Phone:719-599-5668
Mailing Address - Fax:719-599-7467
Practice Address - Street 1:2850 W. SERENDIPITY CIRCLE
Practice Address - Street 2:SUITE 100
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917
Practice Address - Country:US
Practice Address - Phone:719-599-5668
Practice Address - Fax:719-599-7467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-13
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO49225847Medicaid
COCOA101504Medicare PIN