Healthcare Provider Details

I. General information

NPI: 1255470266
Provider Name (Legal Business Name): AMBER SHIELDS MCCOLLUM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMBER LYNN SHIELDS M.D.

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1024 S LEMAY AVE
FORT COLLINS CO
80524-3929
US

IV. Provider business mailing address

PO BOX 912215
DENVER CO
80291-2215
US

V. Phone/Fax

Practice location:
  • Phone: 970-495-7000
  • Fax: 303-306-7753
Mailing address:
  • Phone: 303-306-7101
  • Fax: 303-306-7753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberDR.0049630
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberDR.0049630
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: