Provider Demographics
NPI:1770564908
Name:NORTHERN COLORADO GERIATRICS
Entity type:Organization
Organization Name:NORTHERN COLORADO GERIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEURER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:970-388-3279
Mailing Address - Street 1:2519 S SHIELDS ST
Mailing Address - Street 2:PMB I-143
Mailing Address - City:FT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-1855
Mailing Address - Country:US
Mailing Address - Phone:970-388-3279
Mailing Address - Fax:970-419-4780
Practice Address - Street 1:2519 S SHIELDS ST
Practice Address - Street 2:PMB I-143
Practice Address - City:FT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-1855
Practice Address - Country:US
Practice Address - Phone:970-388-3279
Practice Address - Fax:970-419-4780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO76875363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO80627544Medicaid
CODB5993OtherRR MEDICARE
CO435708Medicare ID - Type Unspecified