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
1	261QD0000X	Dental Clinic/Center
2	261QH0100X	Health Service Clinic/Center
3	261QF0400X	Federally Qualified Health Center (FQHC)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	04004552	OTHER	CO	MCD DENTAL
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	14003031	OTHER	CO	NEW HOPE DENTAL SERVIC
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578539979
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNER CITY HEALTH CENTER

Provider Business Mailing Address
First Line	:	3800 YORK ST.
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80205-3972
Country	:	US
Telephone Number	:	303-296-1767
Fax Number	:	303-296-9313

Provider Business Practice Location Address
First Line	:	3800 YORK ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80205-3540
Country	:	US
Telephone Number	:	303-296-1767
Fax Number	:	303-296-3484

Authorized Official
Title or Position	:	COO
Name	:	ANDREA CORTEZ
Credential	:
Telephone Number	:	720-833-5099

Provider Enumeration Date	:	02/24/2006
Last Update Date	:	01/22/2024

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Directions to “INNER CITY HEALTH CENTER ” Practice Location

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