Healthcare Provider Details

I. General information

NPI: 1972989218
Provider Name (Legal Business Name): CHILDREN'S HOSPITAL COLORADO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2015
Last Update Date: 08/14/2020
Certification Date: 08/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 S UNION BOULEVARD SUITE 255
COLORADO SPRINGS CO
80910-3126
US

IV. Provider business mailing address

13123 EAST 16TH AVENUE, B010
AURORA CO
80045-7106
US

V. Phone/Fax

Practice location:
  • Phone: 719-305-8000
  • Fax: 720-777-7257
Mailing address:
  • Phone: 720-777-1234
  • Fax: 720-777-7391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation 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