Healthcare Provider Details

I. General information

NPI: 1114988458
Provider Name (Legal Business Name): COLUMBINE WOMEN'S CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 LUKE ST STE. A
FT COLLINS CO
80524-4016
US

IV. Provider business mailing address

PO BOX 1418
FT COLLINS CO
80522-1418
US

V. Phone/Fax

Practice location:
  • Phone: 970-225-6100
  • Fax: 970-225-6102
Mailing address:
  • Phone: 970-225-6100
  • Fax: 970-225-6102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number35152
License Number StateCO

VIII. Authorized Official

Name: JONATHAN E FRANCO
Title or Position: OWNER
Credential: M.D.
Phone: 970-225-6100