Provider Demographics
NPI:1760531883
Name:VILLAGE PEDIATRICS
Entity Type:Organization
Organization Name:VILLAGE PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MENAPACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-850-7337
Mailing Address - Street 1:5340 S QUEBEC ST STE 210S
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-1977
Mailing Address - Country:US
Mailing Address - Phone:303-850-7337
Mailing Address - Fax:303-850-7362
Practice Address - Street 1:5340 S QUEBEC ST STE 210S
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-1977
Practice Address - Country:US
Practice Address - Phone:303-850-7337
Practice Address - Fax:303-850-7362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1456174400000X
261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty