Provider Demographics
NPI:1265687966
Name:CHILDREN'S HOSPITAL COLORADO
Entity Type:Organization
Organization Name:CHILDREN'S HOSPITAL COLORADO
Other - Org Name:CHILDREN'S HOSPITAL COLORADO - AUDIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, CHIEF COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-934-5053
Mailing Address - Street 1:13123 E. 16TH AVENUE
Mailing Address - Street 2:BOX 030
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045-7160
Mailing Address - Country:US
Mailing Address - Phone:720-777-6800
Mailing Address - Fax:720-777-7299
Practice Address - Street 1:13123 E 16TH AVE
Practice Address - Street 2:BOX 030
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-7106
Practice Address - Country:US
Practice Address - Phone:720-777-6800
Practice Address - Fax:720-777-7299
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILDREN'S HOSPITAL COLORADO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-21
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO32670575Medicaid