Provider Demographics
NPI:1194942854
Name:PINON FAMILY PRACTICE LLP
Entity type:Organization
Organization Name:PINON FAMILY PRACTICE LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:S
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-948-2676
Mailing Address - Street 1:9895 W. REMINGTON PLACE
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80128-6734
Mailing Address - Country:US
Mailing Address - Phone:303-948-2676
Mailing Address - Fax:303-904-9151
Practice Address - Street 1:9895 W. REMINGTON PLACE
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80128-6734
Practice Address - Country:US
Practice Address - Phone:303-948-2676
Practice Address - Fax:303-904-9151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC370008Medicare PIN
CO=========Medicare UPIN