Provider Demographics
NPI:1629454962
Name:CHILDREN'S HOSPITAL COLORADO
Entity Type:Organization
Organization Name:CHILDREN'S HOSPITAL COLORADO
Other - Org Name:CHILDREN'S HOSPITAL - PUEBLO
Other - Org Type:Other Name
Authorized Official - Title/Position:VP, CHIEF COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-777-6537
Mailing Address - Street 1:13123 EAST 16TH AVENUE, B010
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045-7106
Mailing Address - Country:US
Mailing Address - Phone:720-777-1234
Mailing Address - Fax:720-777-7391
Practice Address - Street 1:704 FORTINO BLVD STE A
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-2087
Practice Address - Country:US
Practice Address - Phone:719-305-8300
Practice Address - Fax:720-777-7257
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILDREN'S HOSPITAL COLORADO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-08-10
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation