Provider Demographics
NPI:1265634539
Name:KIDSFIRST PEDIATRICS PROF., PLLC
Entity Type:Organization
Organization Name:KIDSFIRST PEDIATRICS PROF., PLLC
Other - Org Name:KIDSFIRST PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOMANDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-239-8327
Mailing Address - Street 1:96 WADSWORTH BLVD UNIT 100
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-1516
Mailing Address - Country:US
Mailing Address - Phone:303-239-8327
Mailing Address - Fax:303-239-9946
Practice Address - Street 1:96 WADSWORTH BLVD UNIT 100
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-1516
Practice Address - Country:US
Practice Address - Phone:303-239-8327
Practice Address - Fax:303-239-9946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04021697Medicaid