Provider Demographics
NPI:1225023427
Name:DENVER ARTHRITIS CLINIC PC
Entity type:Organization
Organization Name:DENVER ARTHRITIS CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:A
Authorized Official - Last Name:RENDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-302-7350
Mailing Address - Street 1:7111 E LOWRY BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-7360
Mailing Address - Country:US
Mailing Address - Phone:303-394-2828
Mailing Address - Fax:303-320-0242
Practice Address - Street 1:7111 E LOWRY BLVD STE 200
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80230-7360
Practice Address - Country:US
Practice Address - Phone:303-394-2828
Practice Address - Fax:303-320-0242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-13
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO19871310542174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04737045Medicaid
CODE73704OtherBLUE CROSS BLUE SHIELD
CO73704Medicare ID - Type Unspecified