Provider Demographics
NPI:1013491208
Name:INNER CITY HEALTH CENTER
Entity Type:Organization
Organization Name:INNER CITY HEALTH CENTER
Other - Org Name:WHEAT RIDGE AT INNER CITY HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORTEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-833-5099
Mailing Address - Street 1:3800 N YORK ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-3540
Mailing Address - Country:US
Mailing Address - Phone:303-296-1767
Mailing Address - Fax:303-296-3484
Practice Address - Street 1:6301 W 38TH AVE
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-5057
Practice Address - Country:US
Practice Address - Phone:303-940-9118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INNER CITY HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-09-24
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO4017372Medicaid