Provider Demographics
NPI:1144381419
Name:FAMILY MEDICINE AT CLEMENT PARK
Entity type:Organization
Organization Name:FAMILY MEDICINE AT CLEMENT PARK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-932-2121
Mailing Address - Street 1:6901 S PIERCE ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80128-4552
Mailing Address - Country:US
Mailing Address - Phone:303-932-2121
Mailing Address - Fax:303-948-6704
Practice Address - Street 1:6901 S PIERCE ST
Practice Address - Street 2:SUITE 110
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80128-4552
Practice Address - Country:US
Practice Address - Phone:303-932-2121
Practice Address - Fax:303-948-6704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC362808Medicare PIN