Active NPI
Metro Community Provider Network, Inc.
- Federally Qualified Health Center (FQHC)
- Wheat Ridge, CO
National Provider Identifier
1316233174
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Federally Qualified Health Center (FQHC)
- Legal business name
- METRO COMMUNITY PROVIDER NETWORK, INC.
- Practice address
- 4851 Independence Street
Wheat Ridge, CO 80033-6715 - Phone
- (303) 274-7094
- Fax
- (303) 274-7095
- NPI assigned
- Jun 21, 2011
- Organization subpart
- Yes
- Parent organization
- METRO COMMUNITY PROVIDER NETWORK, INC.
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Ben R. Wiederholt
- Title
- President and Ceo
- Phone
- (303) 761-1977
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | CO | Primary |
Addresses
Primary practice location
4851 Independence Street
Wheat Ridge, CO 80033-6715
Mailing address
2255 S Oneida St
Denver, CO 80224-2522
Phone (303) 761-1977
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 58038230 | Medicaid | CO |
Other names 2
- STRIDE CHC - Independence at Jefferson Center
- Independence Health Center at Jefferson Center for Mental Health
National Provider Directory
National Provider Directory- Part of
- Stride CHC - Parker
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1308614400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1583798400000",
"number": "1316233174",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2255 S ONEIDA ST",
"city": "DENVER",
"state": "CO",
"postal_code": "802242522",
"telephone_number": "303-761-1977",
"fax_number": "303-761-2787"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4851 INDEPENDENCE STREET",
"city": "WHEAT RIDGE",
"state": "CO",
"postal_code": "800336715",
"telephone_number": "303-274-7094",
"fax_number": "303-274-7095"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "METRO COMMUNITY PROVIDER NETWORK, INC.",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "METRO COMMUNITY PROVIDER NETWORK, INC.",
"enumeration_date": "2011-06-21",
"last_updated": "2020-03-10",
"certification_date": "2020-03-10",
"status": "A",
"authorized_official_last_name": "WIEDERHOLT",
"authorized_official_first_name": "BEN",
"authorized_official_middle_name": "R.",
"authorized_official_title_or_position": "PRESIDENT AND CEO",
"authorized_official_telephone_number": "303-761-1977",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "261QF0400X",
"taxonomy_group": "",
"desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
"state": "CO",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "58038230",
"state": "CO"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "STRIDE CHC - Independence at Jefferson Center",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Independence Health Center at Jefferson Center for Mental Health",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Wheat Ridge, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 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.