Healthcare Provider Details

I. General information

NPI: 1720243348
Provider Name (Legal Business Name): CHILDREN'S HOSPITAL COLORADO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2008
Last Update Date: 10/31/2018
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 EAST 16TH AVENUE
AURORA CO
80045-7106
US

V. Phone/Fax

Practice location:
  • Phone: 720-777-1234
  • Fax: 720-777-6597
Mailing address:
  • Phone: 720-777-6537
  • Fax: 720-777-7300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number062311
License Number StateCO

VIII. Authorized Official

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