Provider Demographics
NPI:1417027970
Name:FRONT RANGE NEUROLOGY PC
Entity Type:Organization
Organization Name:FRONT RANGE NEUROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CELINA
Authorized Official - Middle Name:F
Authorized Official - Last Name:TOLGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-353-2255
Mailing Address - Street 1:5890 W 13TH ST
Mailing Address - Street 2:STE 112
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-4816
Mailing Address - Country:US
Mailing Address - Phone:970-353-2255
Mailing Address - Fax:970-353-2579
Practice Address - Street 1:5890 W 13TH ST
Practice Address - Street 2:STE 112
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-4816
Practice Address - Country:US
Practice Address - Phone:970-353-2255
Practice Address - Fax:970-353-2579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO14256061Medicaid
CO14256061Medicaid