| Front Range Clinic Inc. | |
|
1410 Vance St Ste 211 Lakewood CO 80214-5435 | |
| (720) 597-5576 | |
| (970) 639-4475 |
| Full Name | Front Range Clinic Inc. |
|---|---|
| Speciality | Family Medicine - Addiction Medicine |
| Location | 1410 Vance St Ste 211, Lakewood, Colorado |
| Authorized Official Name and Position | Clark Mccoy (PRESIDENT) |
| Authorized Official Contact | 3522147180 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Front Range Clinic Inc. 1040 E Elizabeth St Ste C Fort Collins CO 80524-3952 Ph: (970) 493-9193 | Front Range Clinic Inc. 1410 Vance St Ste 211 Lakewood CO 80214-5435 Ph: (720) 597-5576 |
| NPI Number | 1356860803 |
|---|---|
| Provider Enumeration Date | 09/15/2017 |
| Last Update Date | 02/02/2021 |
| Certification Date | 12/17/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356860803 | NPI | - | NPPES |
| 1598135451 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (NU) | Secondary |
| 207QA0401X | Family Medicine - Addiction Medicine | (NU) | Primary |
| 207QB0002X | Family Medicine - Obesity Medicine | (NU) | Secondary |
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