Provider Demographics
NPI:1528275906
Name:FRONT RANGE FAMILY MEDICINE
Entity type:Organization
Organization Name:FRONT RANGE FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:J
Authorized Official - Last Name:REEDY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:719-262-0852
Mailing Address - Street 1:3260 E WOODMEN RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-3587
Mailing Address - Country:US
Mailing Address - Phone:719-262-0852
Mailing Address - Fax:719-262-0853
Practice Address - Street 1:3260 E WOODMEN RD
Practice Address - Street 2:SUITE 210
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3587
Practice Address - Country:US
Practice Address - Phone:719-262-0852
Practice Address - Fax:719-262-0853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO40494207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO40494OtherSTATE LICENSE
CO800650Medicare ID - Type Unspecified
CO40494OtherSTATE LICENSE
H67878Medicare UPIN