Provider Demographics
NPI:1033377296
Name:ASPEN PARK PEDIATRICS, PC
Entity Type:Organization
Organization Name:ASPEN PARK PEDIATRICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-838-3355
Mailing Address - Street 1:25797 CONIFER RD STE B110
Mailing Address - Street 2:
Mailing Address - City:CONIFER
Mailing Address - State:CO
Mailing Address - Zip Code:80433-9047
Mailing Address - Country:US
Mailing Address - Phone:303-838-3355
Mailing Address - Fax:303-838-8925
Practice Address - Street 1:25797 CONIFER RD STE B110
Practice Address - Street 2:
Practice Address - City:CONIFER
Practice Address - State:CO
Practice Address - Zip Code:80433-9047
Practice Address - Country:US
Practice Address - Phone:303-838-3355
Practice Address - Fax:303-838-8925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO29171208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO00351873Medicaid