Provider Demographics
NPI:1871039784
Name:FRONT RANGE INTEGRATED CLINIC
Entity type:Organization
Organization Name:FRONT RANGE INTEGRATED CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-641-2254
Mailing Address - Street 1:400 INDIANA ST STE 320
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-5033
Mailing Address - Country:US
Mailing Address - Phone:303-641-2254
Mailing Address - Fax:
Practice Address - Street 1:400 INDIANA ST STE 320
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-5033
Practice Address - Country:US
Practice Address - Phone:303-641-2254
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-17
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty