Healthcare Provider Details

I. General information

NPI: 1417521873
Provider Name (Legal Business Name): CHILDREN'S HOSPITAL COLORADO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2021
Last Update Date: 05/19/2021
Certification Date: 04/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

947 S 5TH ST
MONTROSE CO
81401-5716
US

IV. Provider business mailing address

13123 E 16TH AVE # B095
AURORA CO
80045-7106
US

V. Phone/Fax

Practice location:
  • Phone: 970-249-2421
  • Fax:
Mailing address:
  • Phone: 720-777-1234
  • Fax: 720-777-7257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LINDA MICHAEL
Title or Position: VP, CHIEF COMPLIANCE OFFICER
Credential:
Phone: 720-777-6537