Provider Demographics
NPI:1982720785
Name:PEDIATRIC PATHWAYS
Entity Type:Organization
Organization Name:PEDIATRIC PATHWAYS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-694-2323
Mailing Address - Street 1:6909 S HOLLY CIR
Mailing Address - Street 2:STE 150
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-1042
Mailing Address - Country:US
Mailing Address - Phone:303-694-2323
Mailing Address - Fax:303-694-9191
Practice Address - Street 1:6909 S HOLLY CIR
Practice Address - Street 2:STE 150
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-1042
Practice Address - Country:US
Practice Address - Phone:303-694-2323
Practice Address - Fax:303-694-9191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01154756Medicaid