Healthcare Provider Details

I. General information

NPI: 1295183556
Provider Name (Legal Business Name): MEDICAL CENTER OF AURORA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2016
Last Update Date: 05/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 S POTOMAC ST
AURORA CO
80012-5411
US

IV. Provider business mailing address

1501 S POTOMAC ST
AURORA CO
80012-5411
US

V. Phone/Fax

Practice location:
  • Phone: 720-296-9744
  • Fax:
Mailing address:
  • Phone: 720-296-9744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License NumberRN.0202553
License Number StateCO

VIII. Authorized Official

Name: KIM FARRELL
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 303-584-8220