MEDICARE: FORT COLLINS WOMEN'S CLINIC, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VM0101X	Maternal & Fetal Medicine Physician

General Provider Information

NPI Number	:	1770836892
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORT COLLINS WOMEN'S CLINIC, P.C.

Provider Business Mailing Address
First Line	:	1107 SOUTH LEMAY AVENUE
Second Line	:	SUITE 300
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-3955
Country	:	US
Telephone Number	:	970-493-7442
Fax Number	:	970-493-2990

Provider Business Practice Location Address
First Line	:	1107 S LEMAY AVE STE 410
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-3958
Country	:	US
Telephone Number	:	970-294-4464
Fax Number	:	970-482-1973

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	MR. SCOTT KENYON
Credential	:
Telephone Number	:	970-493-7442

Provider Enumeration Date	:	10/26/2012
Last Update Date	:	01/14/2021

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