Provider Demographics
NPI:1598135451
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:
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-214-7180
Mailing Address - Street 1:1040 E ELIZABETH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-3951
Mailing Address - Country:US
Mailing Address - Phone:970-493-9193
Mailing Address - Fax:
Practice Address - Street 1:1040 E ELIZABETH ST
Practice Address - Street 2:SUITE C
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-3951
Practice Address - Country:US
Practice Address - Phone:970-493-9193
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-04
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0054001207Q00000X, 207QA0401X, 207QB0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
No207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity MedicineGroup - Multi-Specialty