| 2100 Broadway Services Building | |
|
2100 Broadway Denver CO 80205-2827 | |
| (303) 297-4091 | |
| (303) 293-2309 |
| Full Name | 2100 Broadway Services Building |
|---|---|
| Speciality | Clinic/Center |
| Location | 2100 Broadway, Denver, Colorado |
| Authorized Official Name and Position | Pete J Stoller (CFO) |
| Authorized Official Contact | 3033129606 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| 2100 Broadway Services Building 2130 Stout Street Denver CO 80205-2526 Ph: (303) 312-9983 | 2100 Broadway Services Building 2100 Broadway Denver CO 80205-2827 Ph: (303) 297-4091 |
| NPI Number | 1346621208 |
|---|---|
| Provider Enumeration Date | 06/16/2015 |
| Last Update Date | 08/11/2020 |
| Medicare PECOS PAC ID | 7618958687 |
|---|---|
| Medicare Enrollment ID | O20150902001890 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346621208 | NPI | - | NPPES |
| 061955 | Other | CO | MEDICARE |
| 90188870 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | CO DOES NOT REQUIRE (Colorado) | Primary |
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