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 State
1	122300000X	Dentist
2	122300000X	Dentist	CO
3	261QF0400X	Federally Qualified Health Center (FQHC)

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811159551
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	:	303-296-4873
Fax Number	:	303-382-2808

Provider Business Practice Location Address
First Line	:	3800 YORK ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80205-3972
Country	:	US
Telephone Number	:	303-296-4873
Fax Number	:	303-382-2808

Authorized Official
Title or Position	:	OPERATIONS MANAGER
Name	:	KARINA VILLAGRANA
Credential	:
Telephone Number	:	720-833-5068

Provider Enumeration Date	:	06/25/2008
Last Update Date	:	11/01/2023

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1518188010 — CARA KHAZOYAN FNP
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1942536248 — KIMBERLY D. FEEHS M.D.
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Directions to “INNER CITY HEALTH CENTER ” Practice Location

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