NPIMap

Organization Active NPI

Fort Collins Youth Clinic

  • Pediatrics Physician
  • Timnath, CO
National Provider Identifier
1043807209
Registry record updated Dec 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
FORT COLLINS YOUTH CLINIC
Practice address
4845 Weitzel St
Timnath, CO 80547-4800
Phone
(970) 267-9510
Fax
(970) 207-9967
NPI assigned
Dec 22, 2020
Last updated
Dec 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Stephanie Fred
Title
Executive Assistant
Phone
(970) 267-9510

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X NU Primary

Addresses

Primary practice location

4845 Weitzel St
Timnath, CO 80547-4800

Mailing address

PO Box 7328
Loveland, CO 80537-0328
Phone (970) 663-2742

National Provider Directory

National Provider Directory
Tax ID family
Fort Collins Youth Clin4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1608595200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1608595200000",
    "number": "1043807209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7328",
            "city": "LOVELAND",
            "state": "CO",
            "postal_code": "805370328",
            "telephone_number": "970-663-2742",
            "fax_number": "970-342-2093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4845 WEITZEL ST",
            "city": "TIMNATH",
            "state": "CO",
            "postal_code": "805474800",
            "telephone_number": "970-267-9510",
            "fax_number": "970-207-9967"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT COLLINS YOUTH CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-22",
        "last_updated": "2020-12-22",
        "certification_date": "2020-12-22",
        "status": "A",
        "authorized_official_last_name": "FRED",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "EXECUTIVE ASSISTANT",
        "authorized_official_telephone_number": "970-267-9510"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Timnath, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.