Provider Demographics
NPI:1902262751
Name:WALNUT RIDGE FAMILY MEDICINE
Entity Type:Organization
Organization Name:WALNUT RIDGE FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:DRECHSLER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:720-593-1994
Mailing Address - Street 1:7110 W 44TH AVE
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-4724
Mailing Address - Country:US
Mailing Address - Phone:720-593-1994
Mailing Address - Fax:
Practice Address - Street 1:7110 W 44TH AVE
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-4724
Practice Address - Country:US
Practice Address - Phone:720-593-1994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-09
Last Update Date:2016-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO49407261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care