MEDICARE: DENVER WEST PEDIATRICS, PC

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	261QP2300X	Primary Care Clinic/Center

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	:	1528064276
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENVER WEST PEDIATRICS, PC

Provider Business Mailing Address
First Line	:	13772 DENVER WEST PKWY
Second Line	:	STE 250
City	:	LAKEWOOD
State	:	CO
Zip	:	80401-3196
Country	:	US
Telephone Number	:	303-216-0333
Fax Number	:	303-216-1511

Provider Business Practice Location Address
First Line	:	13772 DENVER WEST PKWY
Second Line	:	STE 250
City	:	LAKEWOOD
State	:	CO
Zip	:	80401-3196
Country	:	US
Telephone Number	:	303-216-0333
Fax Number	:	303-216-1511

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MARY MORIN
Credential	:
Telephone Number	:	303-216-0333

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	10/15/2007

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