Provider Demographics
NPI:1053654319
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:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BAIJU
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDULLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-390-4335
Mailing Address - Street 1:37 WIDEFIELD BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80911-2126
Mailing Address - Country:US
Mailing Address - Phone:719-390-4335
Mailing Address - Fax:719-390-4566
Practice Address - Street 1:37 WIDEFIELD BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80911-2126
Practice Address - Country:US
Practice Address - Phone:719-390-4335
Practice Address - Fax:719-390-4566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-04
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO27593207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO15622819Medicaid
CO06501575Medicaid