Healthcare Provider Details

I. General information

NPI: 1164236337
Provider Name (Legal Business Name): CHILDREN'S HOSPITAL COLORADO-PREMIER PEDIATRICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2025
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10569 CHAMBERS RD UNIT 101
COMMERCE CITY CO
80022-8951
US

IV. Provider business mailing address

1606 PRAIRIE CENTER PKWY STE 300
BRIGHTON CO
80601-4004
US

V. Phone/Fax

Practice location:
  • Phone: 303-655-1685
  • Fax:
Mailing address:
  • Phone: 303-655-1685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

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