Provider Demographics
NPI:1992878664
Name:FAMILY CARE SPECIALISTS, INC.
Entity type:Organization
Organization Name:FAMILY CARE SPECIALISTS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:MOYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-543-6633
Mailing Address - Street 1:201 LAMKIN ST
Mailing Address - Street 2:UNIT 101
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-3476
Mailing Address - Country:US
Mailing Address - Phone:719-543-6633
Mailing Address - Fax:719-543-6655
Practice Address - Street 1:201 LAMKIN ST
Practice Address - Street 2:UNIT 101
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-3476
Practice Address - Country:US
Practice Address - Phone:719-543-6633
Practice Address - Fax:719-543-6655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO38366207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC437938Medicare PIN