Pediatric Associates Of Canon City, Prof. Llc
Pediatric Adolescent Medicine
Pediatric Associates Of Canon City, Prof. Llc is a Canon City, Colorado based Pediatric center with medical specialization in
Pediatric Adolescent Medicine.
It is located at
1335 Phay Ave, Suite A, Canon City, Colorado - 81212-2334. They can be contacted on phone at
719-269-1727 and fax number 719-269-1730.
NPI number (Unique professional ID) for Pediatric Associates Of Canon City, Prof. Llc is
1457498131 which was assigned by NPPES on 31 Jan, 2007 and it was last updated on 22 Aug, 2020.
Pediatric Associates Of Canon City, Prof. Llc license number is
23117 for Pediatrics Adolescent Medicine (2080A0000X) in Colorado.
Pediatric Associates Of Canon City, Prof. Llc specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs.
Complete Profile:
Pediatric Associates Of Canon City, Prof. Llc basic information including their official name, gender, specialization, credentials etc. are as mentioned below.
| Specialization : | Pediatrics Adolescent Medicine |
|---|
| Provider Name : | Pediatric Associates Of Canon City, Prof. Llc |
|---|
Business Address:
Pediatric Associates Of Canon City, Prof. Llc address, contact phone number and fax are as below. Patients can directly walkin to the clinic or can call on the below given phone number for appointment.
| Primary Address : | 1335 Phay Ave, Suite A
Canon City, CO, 81212-2334
United States |
|---|
| Phone Number : | 719-269-1727 |
|---|
| Fax Number : | 719-269-1730 |
|---|
Professional Identification Codes:
NPI number stands for National Provider Identifier which is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). NPI details are as mentioned below.
| NPI Number : | 1457498131 |
|---|
| NPI Entity Type : | Organization |
|---|
| First Enrolment Date : | 31 Jan, 2007 |
|---|
| Last Updated On : | 22 Aug, 2020 |
|---|
Authorized Official Details:
Officially authorized person to contact for any management issues or complaints of this organization are as below. Person's position and contact details are as mentioned below.
| Authorized Official Name : | Rogerdeane Noland |
|---|
| Official Title or Position : | GENERAL MANAGER |
|---|
| Phone Number : | 719-269-1727 |
|---|
Licenses and Specialities:
Physicians/Organizations can have one or more medical licenses for different specialities in the same state or different states. Related medical licenses for Pediatric Associates Of Canon City, Prof. Llc are as mentioned. Primary taxonomy code for Pediatric Associates Of Canon City, Prof. Llc is
2080A0000X (Pediatrics Adolescent Medicine).
| Taxonomy Code | Speciality | Primary | License No. | State |
|---|
| 2080A0000X | Pediatrics Adolescent Medicine | Yes | 23117 | CO |
Legacy Identifiers:
Other legacy medical identifiers of Pediatric Associates Of Canon City, Prof. Llc such as Medicaid, Medicare PIN, NSC, UPIN etc. are mentioned below.
| Identifier | Identifier Type | State | Issuer |
|---|
| 01271139 | MEDICAID | CO | |
| 05638655 | MEDICAID | CO | |
Mailing Address:
Mailing address can be used for mailing purpose only, for visiting purpose patients need to refer above mentioned business address only.
| Mailing Address : | 1335 Phay Ave, Suite A
Canon City, CO, 81212-2334
United States |
|---|
| Phone Number : | 719-269-1727 |
|---|
| Fax Number : | 719-269-1730 |
|---|
Business Location:
Patients can refer following map for directions to
Pediatric Associates Of Canon City, Prof. Llc practice address. Don't forget to take prior appointment before visiting.
** Data of this site is collected from Medicare & Medicaid Services (CMS) and NPPES.