Healthcare Provider Details

I. General information

NPI: 1275052722
Provider Name (Legal Business Name): FRONT RANGE CLINIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2017
Last Update Date: 12/17/2020
Certification Date: 12/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2224 S FRASER ST UNIT 3
AURORA CO
80014-4532
US

IV. Provider business mailing address

1040 E ELIZABETH ST STE C
FORT COLLINS CO
80524-3952
US

V. Phone/Fax

Practice location:
  • Phone: 720-484-4428
  • Fax: 970-639-4475
Mailing address:
  • Phone: 970-493-9193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CLARK MCCOY
Title or Position: PRESIDENT
Credential: MD
Phone: 352-214-7180