Provider Demographics
NPI:1598801615
Name:FRONT RANGE FLU SHOTS, LLC
Entity Type:Organization
Organization Name:FRONT RANGE FLU SHOTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:NICKEL
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:303-797-3396
Mailing Address - Street 1:7421 S CURTICE CT
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-3952
Mailing Address - Country:US
Mailing Address - Phone:303-797-3396
Mailing Address - Fax:
Practice Address - Street 1:7421 S CURTICE CT
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-3952
Practice Address - Country:US
Practice Address - Phone:303-797-3396
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
COP00017051OtherRAILROAD MEDICARE
CO498758Medicare ID - Type Unspecified