Active NPI
Colorado Functional Medicine
- Family Medicine Physician
- Woodland Park, CO
National Provider Identifier
1346569159
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 45978
- Legal business name
- COLORADO FUNCTIONAL MEDICINE
- Practice address
- 403 S Baldwin St
Woodland Park, CO 80863-3154 - Phone
- (713) 686-7776
- Fax
- (719) 355-1926
- NPI assigned
- May 19, 2010
- Organization subpart
- Yes
- Parent organization
- COLORADO FUNCTIONAL MEDICINE
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Randolph Lee James, MD
- Title
- President
- Phone
- (719) 686-7776
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 45978 | CO | Primary |
Addresses
Primary practice location
403 S Baldwin St
Woodland Park, CO 80863-3154
Mailing address
403 S Baldwin St
Woodland Park, CO 80863-3154
Phone (713) 686-7776
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124011507 | Other | CO | NPI |
| 71189513 | Other | CO | NPI |
Other names 1
- True Life Medicine
National Provider Directory
National Provider Directory- Part of
- Colorado Functional Medicine
Locations
403 S Baldwin St
Woodland Park, CO 80863
Phone (719) 686-7776
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1274227200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1327536000000",
"number": "1346569159",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "403 S BALDWIN ST",
"city": "WOODLAND PARK",
"state": "CO",
"postal_code": "808633154",
"telephone_number": "713-686-7776",
"fax_number": "719-355-1927"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "403 S BALDWIN ST",
"city": "WOODLAND PARK",
"state": "CO",
"postal_code": "808633154",
"telephone_number": "713-686-7776",
"fax_number": "719-355-1926"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "COLORADO FUNCTIONAL MEDICINE",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "COLORADO FUNCTIONAL MEDICINE",
"enumeration_date": "2010-05-19",
"last_updated": "2012-01-26",
"status": "A",
"authorized_official_last_name": "JAMES",
"authorized_official_first_name": "RANDOLPH",
"authorized_official_middle_name": "LEE",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "719-686-7776",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Family Medicine",
"state": "CO",
"license": "45978",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NPI",
"identifier": "1124011507",
"state": "CO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NPI",
"identifier": "71189513",
"state": "CO"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "True Life Medicine",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Woodland Park, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.