MEDICARE: FRONT RANGE PSYCHIATRIC ASSOCIATES, P.C.

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	2084P0800X	Psychiatry Physician		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	:	1447325097
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRONT RANGE PSYCHIATRIC ASSOCIATES, P.C.

Provider Business Mailing Address
First Line	:	56 CLUB MANOR DR
Second Line	:	100
City	:	PUEBLO
State	:	CO
Zip	:	81008-1679
Country	:	US
Telephone Number	:	719-584-4767
Fax Number	:	719-584-4808

Provider Business Practice Location Address
First Line	:	56 CLUB MANOR DR
Second Line	:	100
City	:	PUEBLO
State	:	CO
Zip	:	81008-1679
Country	:	US
Telephone Number	:	719-584-4767
Fax Number	:	719-584-4808

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. STEVEN DANA MARTIN
Credential	:	M.D.
Telephone Number	:	719-584-4767

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	09/27/2013

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