Provider Demographics
NPI:1477679959
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:SR. DIRECTOR OF OE/BI
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTI
Authorized Official - Middle Name:
Authorized Official - Last Name:GARRIOTT
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 1:7495 W 29TH AVE
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-8002
Practice Address - Country:US
Practice Address - Phone:303-761-1977
Practice Address - Fax:303-343-0247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO261QF0400X, 261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01552511Medicaid
CO21477558Medicaid
CO84656581Medicaid
CO9000183608Medicaid
CO9000183615Medicaid
CO86401360Medicaid
CO9000160508Medicaid
CO05638754Medicaid
CO17250048Medicaid
CO9000202877Medicaid
CO9000206459Medicaid
CO69585547Medicaid
CO9000190852Medicaid
CO9000207259Medicaid
CO31601049Medicaid
CO86602373Medicaid
CO05638291Medicaid
CO49105060Medicaid
CO58038230Medicaid
CO60380578Medicaid