MEDICARE: PEDIATRICS AT THE MEADOWS, 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	208000000X	Pediatrics Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851423024
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRICS AT THE MEADOWS, P.C.

Provider Business Mailing Address
First Line	:	3911 AMBROSIA ST STE 100
Second Line	:
City	:	CASTLE ROCK
State	:	CO
Zip	:	80109-3887
Country	:	US
Telephone Number	:	303-688-5226
Fax Number	:	303-814-0717

Provider Business Practice Location Address
First Line	:	3911 AMBROSIA ST STE 100
Second Line	:
City	:	CASTLE ROCK
State	:	CO
Zip	:	80109-3887
Country	:	US
Telephone Number	:	303-688-5226
Fax Number	:	303-814-0717

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	SUSAN CLARK
Credential	:
Telephone Number	:	303-688-5226

Provider Enumeration Date	:	03/12/2007
Last Update Date	:	02/28/2024

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