Provider Demographics
NPI:1821180506
Name:PEDIATRIC & ADOLESCENT MEDICINE
Entity Type:Organization
Organization Name:PEDIATRIC & ADOLESCENT MEDICINE
Other - Org Name:CROWN POINT PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:ROOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-695-7667
Mailing Address - Street 1:9235 CROWN CREST BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-8880
Mailing Address - Country:US
Mailing Address - Phone:303-695-7667
Mailing Address - Fax:303-695-8146
Practice Address - Street 1:9235 CROWN CREST BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-8880
Practice Address - Country:US
Practice Address - Phone:303-695-7667
Practice Address - Fax:303-695-8146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04009304Medicaid