Provider Demographics
NPI:1154357176
Name:WESTMED PRIMARY CARE
Entity type:Organization
Organization Name:WESTMED PRIMARY CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE PRACTICE
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:A
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-450-4691
Mailing Address - Street 1:12201 PECOS ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80234-3888
Mailing Address - Country:US
Mailing Address - Phone:303-457-4497
Mailing Address - Fax:303-450-4692
Practice Address - Street 1:12201 PECOS ST
Practice Address - Street 2:SUITE 500
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80234-3888
Practice Address - Country:US
Practice Address - Phone:303-457-4497
Practice Address - Fax:303-450-4692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CD8572OtherRAILROAD MEDICARE
CD8572OtherRAILROAD MEDICARE