Provider Demographics
NPI:1225419807
Name:COLORADO PREVENTATIVE MEDICINE, INC
Entity Type:Organization
Organization Name:COLORADO PREVENTATIVE MEDICINE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-339-1976
Mailing Address - Street 1:6098 WILLOW SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:MORRISON
Mailing Address - State:CO
Mailing Address - Zip Code:80465-2115
Mailing Address - Country:US
Mailing Address - Phone:707-339-1976
Mailing Address - Fax:
Practice Address - Street 1:6098 WILLOW SPRINGS DR
Practice Address - Street 2:
Practice Address - City:MORRISON
Practice Address - State:CO
Practice Address - Zip Code:80465-2115
Practice Address - Country:US
Practice Address - Phone:707-339-1976
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-09
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0055110261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center