Provider Demographics
NPI:1699562116
Name:PREMIER FAMILY MEDICINE AND MAT
Entity type:Organization
Organization Name:PREMIER FAMILY MEDICINE AND MAT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:L
Authorized Official - Last Name:LARSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-640-1718
Mailing Address - Street 1:2283 S MONACO ST PKWY
Mailing Address - Street 2:SUIT 105
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2283 S MONACO ST PKWY
Practice Address - Street 2:SUIT 105
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222
Practice Address - Country:US
Practice Address - Phone:254-640-1718
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-21
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder