| Colorado Provider Network LLC | |
|
1435 Garrison St Ste 110 Lakewood CO 80215-4748 | |
| (720) 241-3765 | |
| Not Available |
| Full Name | Colorado Provider Network LLC |
|---|---|
| Speciality | Family Medicine |
| Location | 1435 Garrison St Ste 110, Lakewood, Colorado |
| Authorized Official Name and Position | John Marquez (CEO) |
| Authorized Official Contact | 7203203218 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Colorado Provider Network LLC Po Box 12375 Denver CO 80212-0375 Ph: (303) 668-5231 | Colorado Provider Network LLC 1435 Garrison St Ste 110 Lakewood CO 80215-4748 Ph: (720) 241-3765 |
| NPI Number | 1649851155 |
|---|---|
| Provider Enumeration Date | 04/16/2021 |
| Last Update Date | 06/23/2023 |
| Certification Date | 06/23/2023 |
| Medicare PECOS PAC ID | 7315356474 |
|---|---|
| Medicare Enrollment ID | O20210503001121 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649851155 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QA0505X | Family Medicine - Adult Medicine | (NU) | Primary |
| Provider Name | John E Marquez |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1023153723 PECOS PAC ID: 7315044591 Enrollment ID: I20070523000229 |
| Provider Name | Jennifer L Seibert |
|---|---|
| Provider Type | Practitioner - Hospice/palliative Care |
| Provider Identifiers | NPI Number: 1770647216 PECOS PAC ID: 0840396487 Enrollment ID: I20090605000329 |
| Provider Name | Evan Alexandra Glover |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1366912230 PECOS PAC ID: 3274879259 Enrollment ID: I20190111001769 |
| Provider Name | Megan D Edwards |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427674654 PECOS PAC ID: 0042633083 Enrollment ID: I20200708003419 |
| Provider Name | Paul Joseph Hongo |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1598004954 PECOS PAC ID: 0547660805 Enrollment ID: I20210609000409 |
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