Provider Demographics
NPI:1447531462
Name:COLORADO GERIATRIC CARE, PC
Entity type:Organization
Organization Name:COLORADO GERIATRIC CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOO
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:303-831-6686
Mailing Address - Street 1:PO BOX 40065
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-0065
Mailing Address - Country:US
Mailing Address - Phone:303-831-6686
Mailing Address - Fax:720-932-9255
Practice Address - Street 1:2001 LINCOLN ST UNIT 911
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-3850
Practice Address - Country:US
Practice Address - Phone:303-831-6686
Practice Address - Fax:720-932-9255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-03
Last Update Date:2011-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2939363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty