Provider Demographics
NPI:1477833044
Name:THE LOVELAND YOUTH CLINIC
Entity Type:Organization
Organization Name:THE LOVELAND YOUTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINTANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-669-3298
Mailing Address - Street 1:2021 BOISE AVE
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-5037
Mailing Address - Country:US
Mailing Address - Phone:970-669-3298
Mailing Address - Fax:970-669-6244
Practice Address - Street 1:2021 BOISE AVE
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-5037
Practice Address - Country:US
Practice Address - Phone:970-669-3298
Practice Address - Fax:970-669-6244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty