Provider Demographics
NPI:1477598829
Name:VILLAGE MEDICAL CENTER PC
Entity Type:Organization
Organization Name:VILLAGE MEDICAL CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOREL
Authorized Official - Middle Name:
Authorized Official - Last Name:LARONN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-221-0000
Mailing Address - Street 1:5975 S QUEBEC ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80111-4564
Mailing Address - Country:US
Mailing Address - Phone:303-221-0000
Mailing Address - Fax:303-796-0304
Practice Address - Street 1:5975 S QUEBEC ST
Practice Address - Street 2:SUITE 150
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80111-4564
Practice Address - Country:US
Practice Address - Phone:303-221-0000
Practice Address - Fax:303-796-0304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & ImmunologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCE9649OtherRAILROAD MEDICARE
COVIU8608OtherBLUE SHIELD
COCU8608Medicare PIN