Provider Demographics
NPI:1134518467
Name:PRESKEN FAMILY CARE PC
Entity type:Organization
Organization Name:PRESKEN FAMILY CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:SHIRA
Authorized Official - Last Name:PRESKEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:720-556-2001
Mailing Address - Street 1:20971 E SMOKY HILL RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80015-5186
Mailing Address - Country:US
Mailing Address - Phone:720-556-2001
Mailing Address - Fax:720-489-3731
Practice Address - Street 1:20971 E SMOKY HILL RD
Practice Address - Street 2:SUITE 107
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80015-5186
Practice Address - Country:US
Practice Address - Phone:720-556-2001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-09
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO42711207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO44120265Medicaid
CO44120265Medicaid
COG75210Medicare UPIN