Healthcare Provider Details

I. General information

NPI: 1871899583
Provider Name (Legal Business Name): CONNECTED CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2011
Last Update Date: 01/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1217 RIVERSIDE AVE
FORT COLLINS CO
80524-3218
US

IV. Provider business mailing address

1217 RIVERSIDE AVE
FORT COLLINS CO
80524-3218
US

V. Phone/Fax

Practice location:
  • Phone: 970-482-7800
  • Fax:
Mailing address:
  • Phone: 970-482-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LOLLY GUTHRIE
Title or Position: OFFICE MANAGER
Credential:
Phone: 970-482-7800