Provider Demographics
NPI:1952443095
Name:CHILDRENS MEDICAL CENTER PC
Entity Type:Organization
Organization Name:CHILDRENS MEDICAL CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:OHARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-830-7337
Mailing Address - Street 1:1625 MARION ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1514
Mailing Address - Country:US
Mailing Address - Phone:303-830-7337
Mailing Address - Fax:
Practice Address - Street 1:1625 MARION ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1514
Practice Address - Country:US
Practice Address - Phone:303-830-7337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01351857Medicaid
COF76477Medicare UPIN
COE94457Medicare UPIN
CO01351857Medicaid
COD24684Medicare UPIN
COD28095Medicare UPIN
COE30497Medicare UPIN
COF45627Medicare UPIN