Healthcare Provider Details

I. General information

NPI: 1770507360
Provider Name (Legal Business Name): NORTHERN MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 W MIDWAY BLVD
BROOMFIELD CO
80020-2090
US

IV. Provider business mailing address

1420 W MIDWAY BLVD
BROOMFIELD CO
80020-2090
US

V. Phone/Fax

Practice location:
  • Phone: 303-466-1866
  • Fax: 303-466-4081
Mailing address:
  • Phone: 303-466-1866
  • Fax: 303-466-4081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: DR. SHANNON NICOLE HILL
Title or Position: PRESIDENT
Credential: DO
Phone: 303-466-1866