Provider Demographics
NPI:1548352149
Name:FORT COLLINS FAMILY PHYSICIANS PROFESSIONAL LLC
Entity type:Organization
Organization Name:FORT COLLINS FAMILY PHYSICIANS PROFESSIONAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:T
Authorized Official - Last Name:SERRANO-TOY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-221-2290
Mailing Address - Street 1:2121 E HARMONY RD
Mailing Address - Street 2:STE 370
Mailing Address - City:FT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-3404
Mailing Address - Country:US
Mailing Address - Phone:970-221-2290
Mailing Address - Fax:970-295-0036
Practice Address - Street 1:2121 E HARMONY RD
Practice Address - Street 2:STE 370
Practice Address - City:FT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-3404
Practice Address - Country:US
Practice Address - Phone:970-221-2290
Practice Address - Fax:970-295-0036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04118048Medicaid
CO04118048Medicaid