Healthcare Provider Details

I. General information

NPI: 1609031665
Provider Name (Legal Business Name): METRO COMMUNITY PROVIDER NETWORK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2008
Last Update Date: 12/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 COUNTY ROAD 43 SUITE 2
BAILEY CO
80421-2503
US

IV. Provider business mailing address

3701 S BROADWAY
ENGLEWOOD CO
80113-3611
US

V. Phone/Fax

Practice location:
  • Phone: 303-838-1166
  • Fax: 303-838-1124
Mailing address:
  • Phone: 303-761-1977
  • Fax: 303-761-2787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number18J548
License Number StateCO

VIII. Authorized Official

Name: DAVID MYERS
Title or Position: CEO
Credential:
Phone: 303-761-1977