Healthcare Provider Details

I. General information

NPI: 1952443095
Provider Name (Legal Business Name): CHILDRENS MEDICAL CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 MARION ST
DENVER CO
80218-1514
US

IV. Provider business mailing address

1625 MARION ST
DENVER CO
80218-1514
US

V. Phone/Fax

Practice location:
  • Phone: 303-830-7337
  • Fax:
Mailing address:
  • Phone: 303-830-7337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SHARON OHARA
Title or Position: OFFICE MANAGER
Credential:
Phone: 303-830-7337