Provider Demographics
NPI:1720243348
Name:CHILDREN'S HOSPITAL COLORADO
Entity Type:Organization
Organization Name:CHILDREN'S HOSPITAL COLORADO
Other - Org Name:CHILDREN'S HOSPITAL COLORADO - KIDNEY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, CHIEF COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-777-6537
Mailing Address - Street 1:13123 EAST 16TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045-7106
Mailing Address - Country:US
Mailing Address - Phone:720-777-6537
Mailing Address - Fax:720-777-7300
Practice Address - Street 1:13123 E 16TH AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-7106
Practice Address - Country:US
Practice Address - Phone:720-777-1234
Practice Address - Fax:720-777-6597
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILDREN'S HOSPITAL COLORADO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-23
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO062311261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment