Provider Demographics
NPI:1093123481
Name:PEDIATRIC URGENT CARE OF NORTHERN COLORADO
Entity Type:Organization
Organization Name:PEDIATRIC URGENT CARE OF NORTHERN COLORADO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER RELATIONS
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FRED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-267-9510
Mailing Address - Street 1:1200 E ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-4007
Mailing Address - Country:US
Mailing Address - Phone:970-267-9510
Mailing Address - Fax:
Practice Address - Street 1:4845 WEITZEL ST
Practice Address - Street 2:
Practice Address - City:TIMNATH
Practice Address - State:CO
Practice Address - Zip Code:80547-4800
Practice Address - Country:US
Practice Address - Phone:702-679-5109
Practice Address - Fax:970-207-9967
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FORT COLLINS YOUTH CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-29
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty