Provider Demographics
NPI:1083859466
Name:FAMILY CARE MEDICAL CENTER, INC.
Entity type:Organization
Organization Name:FAMILY CARE MEDICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARIS
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SOPHOCLES
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:303-320-8686
Mailing Address - Street 1:1340 LEYDEN ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-2805
Mailing Address - Country:US
Mailing Address - Phone:303-320-8686
Mailing Address - Fax:303-320-1828
Practice Address - Street 1:1340 LEYDEN ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-2805
Practice Address - Country:US
Practice Address - Phone:303-320-8686
Practice Address - Fax:303-320-1828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-12
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO17154207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04002259Medicaid