MEDICARE: INNER CITY HEALTH CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist		CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003078742
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNER CITY HEALTH CENTER

Provider Business Mailing Address
First Line	:	6301 W 38TH AVE
Second Line	:
City	:	WHEAT RIDGE
State	:	CO
Zip	:	80033-5057
Country	:	US
Telephone Number	:	303-940-9118
Fax Number	:

Provider Business Practice Location Address
First Line	:	6301 W 38TH AVE
Second Line	:
City	:	WHEAT RIDGE
State	:	CO
Zip	:	80033-5057
Country	:	US
Telephone Number	:	303-940-9118
Fax Number	:

Authorized Official
Title or Position	:	DENTAL PRACTICE MANAGER
Name	:	KARINA VILLAGRANA
Credential	:
Telephone Number	:	303-296-4873

Provider Enumeration Date	:	06/25/2008
Last Update Date	:	04/15/2022

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Directions to “INNER CITY HEALTH CENTER ” Practice Location

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