FRONT RANGE CLINIC INC. NPI 1104342443

NPI Information

NPI: 1104342443
Provider Name: FRONT RANGE CLINIC INC.
Classification: Family Medicine - 207QA0401X
Entity Type: Organization

Specialization: Addiction Medicine

CLIA Number: 06D2166135

Address:
1308 VIVIAN ST
LONGMONT, CO
ZIP 80501
Phone: (303) 834-8809
Get Directions

FRONT RANGE CLINIC INC. is an addiction medicine family medicine in Longmont, CO. The provider is a family medicine physician who specializes in the diagnosis and treatment of addictions. FRONT RANGE CLINIC INC. NPI is 1104342443. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

1308 VIVIAN ST
LONGMONT, CO
ZIP 80501-217
Phone: (303) 834-8809

The provider's authorized official is Clark Mccoy .
The authorized official title is President and has the following contact phone number (352) 214-7180.

The CLIA number assigned to this NPI record is 06D2166135 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/18/2017 and was last updated on 12/17/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207Q00000X	Family Medicine		0054001	COLORADO	No
2	207QA0401X	Family Medicine	Addiction Medicine	0054001	COLORADO	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1598135451	MEDICAID	COLORADO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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