=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528064276
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DENVER WEST PEDIATRICS, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/27/2005
-----------------------------------------------------
Last Update Date | 10/15/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13772 DENVER WEST PKWY STE 250
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80401-3196
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-216-0333
-----------------------------------------------------
Fax | 303-216-1511
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13772 DENVER WEST PKWY STE 250
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80401-3196
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-216-0333
-----------------------------------------------------
Fax | 303-216-1511
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MARY MORIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 303-216-0333
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------