Provider Demographics
NPI:1427258920
Name:ENDOCRINOLOGY CONSULTANTS OF NORTHERN COLORADO, P.C.
Entity type:Organization
Organization Name:ENDOCRINOLOGY CONSULTANTS OF NORTHERN COLORADO, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:WIDOM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-224-3636
Mailing Address - Street 1:2121 E HARMONY RD UNIT 300
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-3403
Mailing Address - Country:US
Mailing Address - Phone:970-224-9102
Mailing Address - Fax:970-224-9112
Practice Address - Street 1:1040 E ELIZABETH ST
Practice Address - Street 2:UNIT B
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-3951
Practice Address - Country:US
Practice Address - Phone:970-224-3636
Practice Address - Fax:970-224-3637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO32251207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO09026525Medicaid
CODG3569OtherRAILROAD MEDICARE
CO09026525Medicaid