Provider Demographics
NPI:1194854406
Name:PEDIATRICS AT CHERRY CREEK,LLC
Entity Type:Organization
Organization Name:PEDIATRICS AT CHERRY CREEK,LLC
Other - Org Name:PEDIATRICS AT CHERRY CREEK
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELISABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:STAERZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-377-9663
Mailing Address - Street 1:300 S JACKSON ST STE 300
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-3134
Mailing Address - Country:US
Mailing Address - Phone:303-377-9663
Mailing Address - Fax:
Practice Address - Street 1:300 S JACKSON ST STE 300
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-3134
Practice Address - Country:US
Practice Address - Phone:303-377-9663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-04
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO32058208000000X
261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO48571555Medicaid