Provider Demographics
NPI:1528064276
Name:DENVER WEST PEDIATRICS, PC
Entity type:Organization
Organization Name:DENVER WEST PEDIATRICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MORIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-216-0333
Mailing Address - Street 1:13772 DENVER WEST PKWY
Mailing Address - Street 2:STE 250
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80401-3196
Mailing Address - Country:US
Mailing Address - Phone:303-216-0333
Mailing Address - Fax:303-216-1511
Practice Address - Street 1:13772 DENVER WEST PKWY
Practice Address - Street 2:STE 250
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80401-3196
Practice Address - Country:US
Practice Address - Phone:303-216-0333
Practice Address - Fax:303-216-1511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-27
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO32525532Medicaid