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General NPI Number Information
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NPI Number | 1558964734
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Entity Type | Organization
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Legal Business Name | INNER CITY HEALTH CENTER
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Dates
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Enumeration Date | 11/19/2020
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Last Update Date | 11/30/2023
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Provider Practice Location Address
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Address Line | 2301 LAWRENCE ST
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City | DENVER
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State | CO
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Zip | 80205-2126
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Country | US
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Telephone | 303-296-1767
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Fax |
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Provider Business Mailing Address
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Address Line | 3800 N YORK ST
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City | DENVER
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State | CO
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Zip | 80205-3540
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Country | US
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Telephone | 303-296-1767
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Fax |
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | KARINA OLIVIA VILLAGRANA
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Credential |
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Telephone | 303-296-1767
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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