NPIMap

Organization Active NPI

Front Range Clinic Inc.

  • Addiction Medicine (Family Medicine) Physician
  • Lakewood, CO
National Provider Identifier
1356860803
Registry record updated Feb 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction Medicine (Family Medicine) PhysicianTaxonomy code 207QA0401X
Legal business name
FRONT RANGE CLINIC INC.
Practice address
1410 Vance St Ste 211
Lakewood, CO 80214-5435
Phone
(720) 597-5576
Fax
(970) 639-4475
NPI assigned
Sep 15, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2021

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

Authorized official

Name
Dr. Clark McCoy, MDNPI 1871517912
Title
President
Phone
(352) 214-7180

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Addiction Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QA0401X Primary
Obesity Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QB0002X

Addresses

Primary practice location

1410 Vance St Ste 211
Lakewood, CO 80214-5435

Mailing address

1040 E Elizabeth St Ste C
Fort Collins, CO 80524-3952
Phone (970) 493-9193

Other identifiers 1

IdentifierTypeStateIssuer
1598135451MedicaidCO

National Provider Directory

National Provider Directory
Tax ID family
Front Range Clinic Inc19 organizations share this tax ID, including this one

Other organizations with this tax ID 18

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

View all 18

Locations

1410 Vance St
Ste 201
Lakewood, CO 80214

1410 Vance St
Ste 211
Lakewood, CO 80214
Phone (720) 597-5576

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1505433600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612224000000",
    "number": "1356860803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1040 E ELIZABETH ST STE C",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805243952",
            "telephone_number": "970-493-9193",
            "fax_number": "970-639-4475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1410 VANCE ST STE 211",
            "city": "LAKEWOOD",
            "state": "CO",
            "postal_code": "802145435",
            "telephone_number": "720-597-5576",
            "fax_number": "970-639-4475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRONT RANGE CLINIC INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-15",
        "last_updated": "2021-02-02",
        "certification_date": "2020-12-17",
        "status": "A",
        "authorized_official_last_name": "MCCOY",
        "authorized_official_first_name": "CLARK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "352-214-7180",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207QA0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207QB0002X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Obesity Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1598135451",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakewood, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2021; 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.