Provider Demographics
NPI:1871514901
Name:ARBOR FAMILY MEDICINE
Entity type:Organization
Organization Name:ARBOR FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:HAHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-254-8500
Mailing Address - Street 1:3655 E 104TH AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80233-4469
Mailing Address - Country:US
Mailing Address - Phone:303-254-8500
Mailing Address - Fax:303-453-4994
Practice Address - Street 1:3655 E 104TH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80233-4469
Practice Address - Country:US
Practice Address - Phone:303-254-8500
Practice Address - Fax:303-453-4994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO19891023904207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04008918Medicaid
CO04008918Medicaid
COB1808Medicare ID - Type Unspecified