Healthcare Provider Details

I. General information

NPI: 1497155089
Provider Name (Legal Business Name): THOMPSON RIVER PEDIATRICS AND URGENT CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2014
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4435 RONALD REAGAN BLVD.
JOHNSTOWN CO
80534-6409
US

IV. Provider business mailing address

4435 RONALD REAGAN BLVD
JOHNSTOWN CO
80534-6566
US

V. Phone/Fax

Practice location:
  • Phone: 970-619-8139
  • Fax: 970-612-8013
Mailing address:
  • Phone: 970-619-8139
  • Fax: 970-612-8013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0054205
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier76000265
Identifier TypeMEDICAID
Identifier StateCO
Identifier Issuer

VIII. Authorized Official

Name: AMBER GRIFFIN
Title or Position: CEO/CO-OWNER
Credential:
Phone: 970-619-8139