Provider Demographics
NPI:1669871265
Name:BARIATRIC AND METABOLIC CENTER OF COLORADO
Entity type:Organization
Organization Name:BARIATRIC AND METABOLIC CENTER OF COLORADO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DESTRIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-357-4040
Mailing Address - Street 1:9397 CROWN CREST BLVD STE 440
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-8789
Mailing Address - Country:US
Mailing Address - Phone:303-269-4370
Mailing Address - Fax:
Practice Address - Street 1:9397 CROWN CREST BLVD STE 440
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-8789
Practice Address - Country:US
Practice Address - Phone:303-269-4370
Practice Address - Fax:303-269-4371
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PORTERCARE ADVENTIST HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0004017363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty