Provider Demographics
NPI:1467451336
Name:MOUNTAIN FAMILY HEALTH CENTERS
Entity type:Organization
Organization Name:MOUNTAIN FAMILY HEALTH CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:ELMA
Authorized Official - Last Name:HOWELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:303-582-5276
Mailing Address - Street 1:PO BOX 66
Mailing Address - Street 2:
Mailing Address - City:BLACK HAWK
Mailing Address - State:CO
Mailing Address - Zip Code:80422-0066
Mailing Address - Country:US
Mailing Address - Phone:303-582-5276
Mailing Address - Fax:303-582-3929
Practice Address - Street 1:562 GREGORY ST
Practice Address - Street 2:
Practice Address - City:BLACK HAWK
Practice Address - State:CO
Practice Address - Zip Code:80422-0066
Practice Address - Country:US
Practice Address - Phone:303-582-5276
Practice Address - Fax:303-582-3929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO30655261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01306554Medicaid
COB04308Medicare ID - Type Unspecified
CO01306554Medicaid