MEDICARE: PEDIATRIC URGENT CARE OF NORTHERN COLORADO

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	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1093123481
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRIC URGENT CARE OF NORTHERN COLORADO

Provider Business Mailing Address
First Line	:	1200 E ELIZABETH ST
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-4007
Country	:	US
Telephone Number	:	970-267-9510
Fax Number	:

Provider Business Practice Location Address
First Line	:	4845 WEITZEL ST
Second Line	:
City	:	TIMNATH
State	:	CO
Zip	:	80547-4800
Country	:	US
Telephone Number	:	702-679-5109
Fax Number	:	970-207-9967

Authorized Official
Title or Position	:	PROVIDER RELATIONS
Name	:	STEPHANIE FRED
Credential	:
Telephone Number	:	970-267-9510

Provider Enumeration Date	:	07/29/2014
Last Update Date	:	04/28/2021

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