Provider Demographics
NPI:1770528424
Name:KIEFT, CLOYD & HOFFMANN, PC
Entity type:Organization
Organization Name:KIEFT, CLOYD & HOFFMANN, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:R
Authorized Official - Last Name:FUCIARELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-686-9541
Mailing Address - Street 1:1136 E STUART ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-1197
Mailing Address - Country:US
Mailing Address - Phone:970-493-5904
Mailing Address - Fax:970-493-5973
Practice Address - Street 1:1136 E STUART ST
Practice Address - Street 2:#2100
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-1195
Practice Address - Country:US
Practice Address - Phone:970-493-5904
Practice Address - Fax:970-493-5973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO21392174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04006631Medicaid
COF8308Medicare ID - Type Unspecified