Provider Demographics
NPI:1902493703
Name:CENTER POINTE FAMILY MEDICINE LLC
Entity Type:Organization
Organization Name:CENTER POINTE FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BAIJU
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDULLA
Authorized Official - Suffix:
Authorized Official - Credentials:MBBS
Authorized Official - Phone:719-282-6100
Mailing Address - Street 1:5410 POWERS CENTER PT STE 230
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-7148
Mailing Address - Country:US
Mailing Address - Phone:719-282-6100
Mailing Address - Fax:719-282-6106
Practice Address - Street 1:5410 POWERS CENTER PT STE 230
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7148
Practice Address - Country:US
Practice Address - Phone:719-282-6100
Practice Address - Fax:719-282-6106
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTER POINTE FAMILY MEDICINE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000141709Medicaid