| Longs Peak Family Practice, Pc | |
|
1309 Sunset St Longmont CO 80501-3215 | |
| (303) 772-5578 | |
| (303) 772-8207 |
| Full Name | Longs Peak Family Practice, Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 1309 Sunset St, Longmont, Colorado |
| Authorized Official Name and Position | Susan I Roach (OFFICER) |
| Authorized Official Contact | 3037725578 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Longs Peak Family Practice, Pc 1309 Sunset St Longmont CO 80501-3215 Ph: (303) 772-5578 | Longs Peak Family Practice, Pc 1309 Sunset St Longmont CO 80501-3215 Ph: (303) 772-5578 |
| NPI Number | 1477565380 |
|---|---|
| Provider Enumeration Date | 08/12/2006 |
| Last Update Date | 02/08/2008 |
| Medicare PECOS PAC ID | 8527036128 |
|---|---|
| Medicare Enrollment ID | O20040921001319 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477565380 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 207QS0010X | Family Medicine - Sports Medicine | (* (Not Available)) | Secondary |
| Provider Name | Christopher C Madden |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1689676819 PECOS PAC ID: 3173659182 Enrollment ID: I20100330000162 |
| Provider Name | Rebecca Ann Myers |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1417116146 PECOS PAC ID: 6305093527 Enrollment ID: I20120823000206 |
| Provider Name | Allison M Mitas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013220565 PECOS PAC ID: 8123142858 Enrollment ID: I20131029001727 |
| Provider Name | Eric Andrew Traister |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1104141670 PECOS PAC ID: 5496971343 Enrollment ID: I20140729002512 |
| Provider Name | Allison Fostveit |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487068151 PECOS PAC ID: 3779705876 Enrollment ID: I20141105000294 |
| Provider Name | James T Keeling |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1154717676 PECOS PAC ID: 8325346463 Enrollment ID: I20180628000347 |
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