1396407516 NPI number — KIDS FIRST HEALTH CARE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396407516 NPI number — KIDS FIRST HEALTH CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KIDS FIRST HEALTH CARE
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:
Provider Other Organization Name Type Code:
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:
1396407516
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7190 COLORADO BLVD STE 450
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COMMERCE CITY
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80022-1847
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-289-1086
Provider Business Mailing Address Fax Number:
303-289-7378

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6160 KEARNEY ST
Provider Second Line Business Practice Location Address:
KEARNEY MIDDLE SCHOOL
Provider Business Practice Location Address City Name:
COMMERCE CITY
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-286-0566
Provider Business Practice Location Address Fax Number:
303-286-0572
Provider Enumeration Date:
10/06/2021

Additional Information

Authorized Official

Authorized Official Last Name:
LURIE
Authorized Official First Name:
JONATHAN
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR ADMIN & FINANCE
Authorized Official Telephone Number:
303-853-3282

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 78125051 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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