Provider Demographics
NPI:1801556931
Name:COMPLETE CARE PEDIATRICS
Entity type:Organization
Organization Name:COMPLETE CARE PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:MOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:GILPIN
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C, IBCLC
Authorized Official - Phone:303-929-6492
Mailing Address - Street 1:2801 YOUNGFIELD ST STE 120
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-0208
Mailing Address - Country:US
Mailing Address - Phone:303-929-6492
Mailing Address - Fax:
Practice Address - Street 1:2801 YOUNGFIELD ST STE 120
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-0208
Practice Address - Country:US
Practice Address - Phone:303-929-6492
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-30
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1714OtherCOLORADO STATE LICENSE
CO74874811Medicaid