Provider Demographics
NPI:1528240827
Name:FRONT RANGE INTERNAL MEDICINE PC
Entity type:Organization
Organization Name:FRONT RANGE INTERNAL MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KNUTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-788-1620
Mailing Address - Street 1:499 E HAMPDEN AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-2780
Mailing Address - Country:US
Mailing Address - Phone:303-788-1620
Mailing Address - Fax:303-788-4097
Practice Address - Street 1:499 E HAMPDEN AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2780
Practice Address - Country:US
Practice Address - Phone:303-788-1620
Practice Address - Fax:303-788-4097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO26561207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCS6748OtherRAILROAD MEDICARE
CO04008470Medicaid
COFR96708OtherBLUE CROSS AND BLUE SHIEL
COC96708Medicare PIN