Med Peds Clinic of Fort Collins, LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

MED PEDS CLINIC OF FORT COLLINS, LLC

Practice address

4674 Snow Mesa Drive
Ste 120
Fort Collins, CO 80528

Phone

(970) 266-3650

Fax

(970) 266-3660

NPI assigned

Sep 20, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Mark Simmons, M.D.

Title

Physician

Phone

(970) 266-3650

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217289600000",
    "number": "1427155845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4674 SNOW MESA DRIVE",
            "address_2": "STE 120",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "80528",
            "telephone_number": "970-266-3650",
            "fax_number": "970-266-3660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4674 SNOW MESA DRIVE",
            "address_2": "STE 120",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "80528",
            "telephone_number": "970-266-3650",
            "fax_number": "970-266-3660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MED PEDS CLINIC OF FORT COLLINS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2008-07-29",
        "status": "A",
        "authorized_official_last_name": "SIMMONS",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "970-266-3650",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "CO",
            "license": null,
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "CO",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2008; 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.