Provider Demographics
NPI:1992137988
Name:COMMUNITY SUPPORTED FAMILY MEDICINE LLC
Entity type:Organization
Organization Name:COMMUNITY SUPPORTED FAMILY MEDICINE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:DICKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-883-1417
Mailing Address - Street 1:3333 S BANNOCK ST STE 820
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80110-2422
Mailing Address - Country:US
Mailing Address - Phone:303-883-1417
Mailing Address - Fax:303-500-6966
Practice Address - Street 1:3333 S BANNOCK ST STE 820
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80110-2422
Practice Address - Country:US
Practice Address - Phone:303-883-1417
Practice Address - Fax:303-500-6966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-01
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO47573261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care