MEDICARE: CATHOLIC HEALTH INITIATIVES 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	207Q00000X	Family Medicine Physician

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	:	1992171219
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CATHOLIC HEALTH INITIATIVES COLORADO

Provider Business Mailing Address
First Line	:	PO BOX 911057
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80291-1057
Country	:	US
Telephone Number	:	303-643-1099
Fax Number	:	303-643-1176

Provider Business Practice Location Address
First Line	:	1263 LAKE PLAZA DR
Second Line	:	SUITE 230
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-3564
Country	:	US
Telephone Number	:	719-776-3300
Fax Number	:	719-776-3329

Authorized Official
Title or Position	:	OMA / ADMINISTRATOR
Name	:	ANGELA SKINNER
Credential	:
Telephone Number	:	303-673-7175

Provider Enumeration Date	:	08/20/2015
Last Update Date	:	04/20/2016

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