Provider Demographics
NPI:1942906656
Name:MY PLACE PEDIATRICS, LLC
Entity Type:Organization
Organization Name:MY PLACE PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:TANN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:720-432-0244
Mailing Address - Street 1:700 12TH ST STE 220
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-1231
Mailing Address - Country:US
Mailing Address - Phone:720-432-0244
Mailing Address - Fax:
Practice Address - Street 1:700 12TH ST STE 220
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-1231
Practice Address - Country:US
Practice Address - Phone:720-432-0244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-03
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health