Provider Demographics
NPI:1477553014
Name:UNIVERSITY OF COLORADO
Entity Type:Organization
Organization Name:UNIVERSITY OF COLORADO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CORY
Authorized Official - Middle Name:
Authorized Official - Last Name:SITES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-315-5213
Mailing Address - Street 1:13624 N TRAVOIS TRL
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-8617
Mailing Address - Country:US
Mailing Address - Phone:303-841-0158
Mailing Address - Fax:
Practice Address - Street 1:4200 E 9TH AVE
Practice Address - Street 2:BOX C288-5
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80262-0001
Practice Address - Country:US
Practice Address - Phone:303-315-5213
Practice Address - Fax:303-315-1750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO57477261QP2300X, 322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Not Answered322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07574775Medicaid