Provider Demographics
NPI:1114988458
Name:COLUMBINE WOMEN'S CLINIC
Entity Type:Organization
Organization Name:COLUMBINE WOMEN'S CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:FRANCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-225-6100
Mailing Address - Street 1:PO BOX 1418
Mailing Address - Street 2:
Mailing Address - City:FT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80522-1418
Mailing Address - Country:US
Mailing Address - Phone:970-225-6100
Mailing Address - Fax:970-225-6102
Practice Address - Street 1:1020 LUKE ST
Practice Address - Street 2:STE. A
Practice Address - City:FT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-4016
Practice Address - Country:US
Practice Address - Phone:970-225-6100
Practice Address - Fax:970-225-6102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO35152207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COG11966Medicare UPIN
CO801563Medicare ID - Type Unspecified