Provider Demographics
NPI:1538431945
Name:CO FIDELIS PC
Entity type:Organization
Organization Name:CO FIDELIS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:M
Authorized Official - Last Name:DORNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-408-2488
Mailing Address - Street 1:4600 S SYRACUSE ST
Mailing Address - Street 2:9TH FLOOR
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-2750
Mailing Address - Country:US
Mailing Address - Phone:303-223-4949
Mailing Address - Fax:866-776-6641
Practice Address - Street 1:4600 S SYRACUSE ST
Practice Address - Street 2:9TH FLOOR
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80237-2750
Practice Address - Country:US
Practice Address - Phone:303-223-4949
Practice Address - Fax:866-776-6641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-31
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty