Provider Demographics
NPI:1306307665
Name:STAPLETON PEDIATRICS
Entity type:Organization
Organization Name:STAPLETON PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEMKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-626-7955
Mailing Address - Street 1:2975 ROSLYN ST UNIT 100
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80238-3326
Mailing Address - Country:US
Mailing Address - Phone:303-399-7900
Mailing Address - Fax:303-799-7999
Practice Address - Street 1:1258 S PEARL ST STE 110
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-1538
Practice Address - Country:US
Practice Address - Phone:303-399-7970
Practice Address - Fax:303-399-7905
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STAPLETON PEDIATRICS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-28
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO17402221Medicaid