Active NPI
Heron Lake LLC
- Clinic/Center
- Loveland, CO
National Provider Identifier
1407012826
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinic/Center
- Legal business name
- HERON LAKE LLC
- Practice address
- 1625 Foxtrail Dr
Ste 190
Loveland, CO 80538-9088 - Phone
- (970) 619-6900
- Fax
- (970) 619-6990
- NPI assigned
- Aug 5, 2008
- Organization subpart
- Yes
- Parent organization
- HERON LAKE LLC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Stephanie Doughty
- Title
- Cfo
- Phone
- (970) 237-7003
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | Primary |
Addresses
Primary practice location
1625 Foxtrail Dr
Ste 190
Loveland, CO 80538-9088
Mailing address
2695 Rocky Mountain Ave
Ste 150
Loveland, CO 80538-8702
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 92181031 | Medicaid | CO |
Other names 1
- Foxtrail Family Medicine
National Provider Directory
National Provider Directory- Part of
- Heron Lake LLC
Member of 1
Organizations this organization is a member of, according to the National Provider Directory.
-
dba Poudre Valley Health System
- General Acute Care Hospital
- Greeley, CO
- NPI 1962158857
Member Of
Locations
1625 Foxtrail Dr
Ste 109
Loveland, CO 80538
Phone (970) 619-6900
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Anesthesiology Physician
- Fort Collins, CO
- NPI 1821086513
-
- Family Medicine Physician
- Portage, WI
- NPI 1821055583
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1217894400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1389657600000",
"number": "1407012826",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2695 ROCKY MOUNTAIN AVE",
"address_2": "STE 150",
"city": "LOVELAND",
"state": "CO",
"postal_code": "805388702"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1625 FOXTRAIL DR",
"address_2": "STE 190",
"city": "LOVELAND",
"state": "CO",
"postal_code": "805389088",
"telephone_number": "970-619-6900",
"fax_number": "970-619-6990"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "HERON LAKE LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "HERON LAKE LLC",
"enumeration_date": "2008-08-05",
"last_updated": "2014-01-14",
"status": "A",
"authorized_official_last_name": "DOUGHTY",
"authorized_official_first_name": "STEPHANIE",
"authorized_official_title_or_position": "CFO",
"authorized_official_telephone_number": "970-237-7003"
},
"taxonomies": [
{
"code": "261Q00000X",
"taxonomy_group": "",
"desc": "Clinic/Center",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "92181031",
"state": "CO"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Foxtrail Family Medicine",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Loveland, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.