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6260 E Colfax Ave Denver CO 80220-1515 | |
| (303) 863-0772 | |
| (303) 832-7823 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 6260 E Colfax Ave, Denver, Colorado |
| Authorized Official Name and Position | Lili Carrillo (CHIEF CLINICAL OFFICER) |
| Authorized Official Contact | 3039625317 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
6260 E Colfax Ave Denver CO 80220-1515 Ph: (303) 837-0166 | 6260 E Colfax Ave Denver CO 80220-1515 Ph: (303) 863-0772 |
| NPI Number | 1316353485 |
|---|---|
| Provider Enumeration Date | 07/09/2014 |
| Last Update Date | 03/15/2023 |
| Medicare PECOS PAC ID | 1254789803 |
|---|---|
| Medicare Enrollment ID | O20231121001693 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316353485 | NPI | - | NPPES |
| 93637357 | Medicaid | CO | |
| 04016572 | Other | CO | PROVIDER NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Secondary |
| Provider Name | Jose Alberto Diaz Leo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700359536 PECOS PAC ID: 0749600724 Enrollment ID: I20231121001726 |
| Provider Name | Victoria Virginia Cervi |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356989529 PECOS PAC ID: 4981042207 Enrollment ID: I20240405001907 |
| Provider Name | Samuel Wesley Harrison |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023751211 PECOS PAC ID: 8921446253 Enrollment ID: I20240405002130 |
| Provider Name | Danielle Geno Willis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1699107607 PECOS PAC ID: 2062850274 Enrollment ID: I20240408001637 |
| Provider Name | Garrett Meyer Levi |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1639883069 PECOS PAC ID: 9133567340 Enrollment ID: I20240408001690 |
| Provider Name | Amelia Lynn Stoll |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1700423548 PECOS PAC ID: 5496196586 Enrollment ID: I20240507001776 |
| Provider Name | Rebecca Anne Mclaughlin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1578264925 PECOS PAC ID: 2567997927 Enrollment ID: I20241121002172 |
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