Provider Demographics
NPI:1255591780
Name:METRO COMMUNITY PROVIDER NETWORK, INC.
Entity type:Organization
Organization Name:METRO COMMUNITY PROVIDER NETWORK, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:
Authorized Official - Last Name:PEER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-761-1977
Mailing Address - Street 1:7495 W 29TH AVE
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-8002
Mailing Address - Country:US
Mailing Address - Phone:303-761-1977
Mailing Address - Fax:303-343-0247
Practice Address - Street 1:3292 PEORIA STREET
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80110-1517
Practice Address - Country:US
Practice Address - Phone:303-343-6642
Practice Address - Fax:303-343-6932
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:METRO COMMUNITY PROVIDER NETWORK, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-09
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO333600000X, 333600000X
333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0621816OtherNCPDP
CO01552511Medicaid
CO01552511Medicaid