Healthcare Provider Details

I. General information

NPI: 1649276536
Provider Name (Legal Business Name): HEART & VASCULAR CLINIC OF NORTHERN COLORADO, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 02/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 E HARMONY RD UNIT 200
FORT COLLINS CO
80528-3401
US

IV. Provider business mailing address

2121 E HARMONY RD UNIT 200
FORT COLLINS CO
80528-3401
US

V. Phone/Fax

Practice location:
  • Phone: 970-221-1000
  • Fax: 970-221-1544
Mailing address:
  • Phone: 970-221-1000
  • Fax: 970-221-1544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number StateCO
# 5
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number StateCO
# 6
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number StateCO
# 7
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateCO

VIII. Authorized Official

Name: MR. DALE RICHARDSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 970-227-6931