Provider Demographics
NPI:1467963447
Name:FRONT RANGE CLINIC INC.
Entity Type:Organization
Organization Name:FRONT RANGE CLINIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CLARK
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-493-9193
Mailing Address - Street 1:1040 E ELIZABETH ST STE C
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-3952
Mailing Address - Country:US
Mailing Address - Phone:970-493-9193
Mailing Address - Fax:970-639-4475
Practice Address - Street 1:1040 E ELIZABETH ST STE C
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-3952
Practice Address - Country:US
Practice Address - Phone:970-493-9193
Practice Address - Fax:970-639-4475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-18
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty