NPIMap

Organization Active NPI

Metro Community Provider Network, Inc.

Doing business as STRIDE CHC - Potomac Street Dental Clinic

  • Federally Qualified Health Center (FQHC)
  • Aurora, CO
National Provider Identifier
1578184073
Registry record updated May 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
METRO COMMUNITY PROVIDER NETWORK, INC.
Doing business as
STRIDE CHC - Potomac Street Dental Clinic
Practice address
750 Potomac St Ste L23
Aurora, CO 80011-6742
Phone
(303) 360-6276
NPI assigned
May 6, 2020
Last updated
May 6, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
METRO COMMUNITY PROVIDER NETWORK, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on May 6, 2020

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

Authorized official

Name
Ben Wiederholt
Title
President & Ceo
Phone
(303) 761-1977

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

750 Potomac St Ste L23
Aurora, CO 80011-6742

Mailing address

2255 S Oneida St
Denver, CO 80224-2522
Phone (303) 360-6276

Other names 1

  • STRIDE CHC - Potomac Street Dental Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Metro Community Provider Networkinc36 organizations share this tax ID, including this one
Part of
Metro Community Provider Networkinc

Other organizations with this tax ID 35

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

View all 35

NPI Registry JSON

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

{
    "created_epoch": "1588723200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588723200000",
    "number": "1578184073",
    "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": "303-360-6276"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 POTOMAC ST STE L23",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800116742",
            "telephone_number": "303-360-6276"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "METRO COMMUNITY PROVIDER NETWORK, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "METRO COMMUNITY PROVIDER NETWORK, INC.",
        "enumeration_date": "2020-05-06",
        "last_updated": "2020-05-06",
        "certification_date": "2020-05-06",
        "status": "A",
        "authorized_official_last_name": "WIEDERHOLT",
        "authorized_official_first_name": "BEN",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "303-761-1977"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "STRIDE CHC - Potomac Street Dental Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Aurora, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 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.