Provider Demographics
NPI:1063659522
Name:FRONT RANGE ENT, PC
Entity Type:Organization
Organization Name:FRONT RANGE ENT, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:L
Authorized Official - Last Name:MALONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-584-1063
Mailing Address - Street 1:6500 29TH STREET
Mailing Address - Street 2:SUITE 106
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-8386
Mailing Address - Country:US
Mailing Address - Phone:970-330-5555
Mailing Address - Fax:
Practice Address - Street 1:6500 29TH STREET
Practice Address - Street 2:SUITE 106
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-8386
Practice Address - Country:US
Practice Address - Phone:970-330-5555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-20
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO41311207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty