Provider Demographics
NPI:1285151878
Name:COLORADO UROLOGY CLINIC, PC
Entity type:Organization
Organization Name:COLORADO UROLOGY CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:303-388-9321
Mailing Address - Street 1:871 THORNTON PARKWAY
Mailing Address - Street 2:SUITE 256
Mailing Address - City:THOMTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229-3681
Mailing Address - Country:US
Mailing Address - Phone:303-388-9321
Mailing Address - Fax:303-388-3910
Practice Address - Street 1:9141 GRANT ST
Practice Address - Street 2:SUITE 245
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-4374
Practice Address - Country:US
Practice Address - Phone:303-388-9321
Practice Address - Fax:303-388-3910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-24
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO59721723Medicaid