Provider Demographics
NPI:1285675363
Name:COLORADO INTERNAL MEDICINE CENTER, P.C.
Entity type:Organization
Organization Name:COLORADO INTERNAL MEDICINE CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHERYL
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-320-7744
Mailing Address - Street 1:4545 E 9 AVE
Mailing Address - Street 2:#670
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220
Mailing Address - Country:US
Mailing Address - Phone:303-320-7744
Mailing Address - Fax:303-388-2003
Practice Address - Street 1:4545 E 9TH AVE
Practice Address - Street 2:#670
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-3901
Practice Address - Country:US
Practice Address - Phone:303-320-7744
Practice Address - Fax:303-388-2003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCI9125OtherRAILROAD MEDICARE
CO74474073Medicaid
COCI9125OtherRAILROAD MEDICARE