Provider Demographics
NPI:1598390247
Name:MVC COLORADO PC
Entity Type:Organization
Organization Name:MVC COLORADO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROJECT ASSOCIATE
Authorized Official - Prefix:
Authorized Official - First Name:KAITLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:DURVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-874-4999
Mailing Address - Street 1:82 HARTWELL ST
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02721-3025
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6795 E TENNESSEE AVE STE 175
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80224-1646
Practice Address - Country:US
Practice Address - Phone:303-690-4882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty