Provider Demographics
NPI:1477667244
Name:PLATTE RIVER MEDICAL CLINIC LLC
Entity Type:Organization
Organization Name:PLATTE RIVER MEDICAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:MS
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:EUSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-659-7600
Mailing Address - Street 1:2801 PURCELL ST
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-3551
Mailing Address - Country:US
Mailing Address - Phone:303-659-7600
Mailing Address - Fax:303-558-8223
Practice Address - Street 1:2801 PURCELL ST
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-3551
Practice Address - Country:US
Practice Address - Phone:303-659-7600
Practice Address - Fax:303-558-8223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO95158260Medicaid
CO95158260Medicaid