1295328243 NPI number — METRO COMMUNITY PROVIDER NETWORK,INC

Table of content: (NPI 1295328243)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295328243 NPI number — METRO COMMUNITY PROVIDER NETWORK,INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
METRO COMMUNITY PROVIDER NETWORK,INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
STRIDE CHC - MOBILE HEALTH UNIT #3
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295328243
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2255 S ONEIDA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80224-2522
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-360-6276
Provider Business Mailing Address Fax Number:
303-343-0247

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3515 S DELAWARE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ENGLEWOOD
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80110-3529
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-360-6276
Provider Business Practice Location Address Fax Number:
303-789-7222
Provider Enumeration Date:
02/19/2021

Additional Information

Authorized Official

Authorized Official Last Name:
GARRIOTT
Authorized Official First Name:
CHRISTI
Authorized Official Middle Name:
Authorized Official Title or Position:
SR. DIRECTOR OF OE/B
Authorized Official Telephone Number:
303-761-1977

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 9000206602 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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