Healthcare Provider Details

I. General information

NPI: 1033685797
Provider Name (Legal Business Name): CHILDREN'S HOSPITAL COLORADO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2018
Last Update Date: 11/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13123 E 16TH AVE
AURORA CO
80045-7106
US

IV. Provider business mailing address

13123 E 16TH AVE
AURORA CO
80045-7106
US

V. Phone/Fax

Practice location:
  • Phone: 720-777-1234
  • Fax:
Mailing address:
  • Phone: 720-777-2566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LINDA MICHAEL
Title or Position: VP, CHIEF COMPLIANCE OFFICER
Credential:
Phone: 720-777-6537