Provider Demographics
NPI:1215084652
Name:ARVADA PEDIATRIC ASSOCIATES, PC
Entity type:Organization
Organization Name:ARVADA PEDIATRIC ASSOCIATES, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARYL
Authorized Official - Middle Name:B
Authorized Official - Last Name:LEBLANC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-421-6873
Mailing Address - Street 1:8030 LEE DR
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80005-2078
Mailing Address - Country:US
Mailing Address - Phone:303-421-6873
Mailing Address - Fax:303-421-9922
Practice Address - Street 1:8030 LEE DR
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80005-2078
Practice Address - Country:US
Practice Address - Phone:303-421-6873
Practice Address - Fax:303-421-9922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04126041Medicaid
CO04126041Medicaid