Provider Demographics
NPI:1063543023
Name:COLORADO GERIATRIC CARE, PC
Entity type:Organization
Organization Name:COLORADO GERIATRIC CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:C
Authorized Official - Last Name:KOHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-423-6894
Mailing Address - Street 1:PO BOX 40065
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-0065
Mailing Address - Country:US
Mailing Address - Phone:303-831-6686
Mailing Address - Fax:
Practice Address - Street 1:2460 W 26TH AVE
Practice Address - Street 2:SUITE C360
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-5308
Practice Address - Country:US
Practice Address - Phone:303-831-6686
Practice Address - Fax:720-932-9255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO41657207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO57476586Medicaid
COC808036Medicare PIN