Provider Demographics
NPI:1851423024
Name:PEDIATRICS AT THE MEADOWS, P.C.
Entity Type:Organization
Organization Name:PEDIATRICS AT THE MEADOWS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-688-5226
Mailing Address - Street 1:3911 AMBROSIA ST STE 100
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80109-3887
Mailing Address - Country:US
Mailing Address - Phone:303-688-5226
Mailing Address - Fax:303-814-0717
Practice Address - Street 1:3911 AMBROSIA ST STE 100
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80109-3887
Practice Address - Country:US
Practice Address - Phone:303-688-5226
Practice Address - Fax:303-814-0717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO98903314Medicaid