Metro Community Provider Network, Inc.

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

METRO COMMUNITY PROVIDER NETWORK, INC.

Doing business as

STRIDE CHC - Jefferson Plaza Family Health at Jefferson Center

Practice address

3595 South Teller Street
Lakewood, CO 80235-2014

Phone

(303) 239-9964

Fax

(303) 237-4343

NPI assigned

Feb 5, 2016

Last updated

Mar 10, 2020By the provider in NPPES

Organization subpart

Yes

Parent organization

METRO COMMUNITY PROVIDER NETWORK, INC.As reported in NPPES

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

Addresses

Other identifiers 1

Other names 1

• STRIDE CHC - Jefferson Plaza Family Health at Jefferson Center Doing business as

Part of

Stride CHC - Parker

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

{
    "created_epoch": "1454630400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583798400000",
    "number": "1679931646",
    "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": "3595 SOUTH TELLER STREET",
            "city": "LAKEWOOD",
            "state": "CO",
            "postal_code": "802352014",
            "telephone_number": "303-239-9964",
            "fax_number": "303-237-4343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "METRO COMMUNITY PROVIDER NETWORK, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "METRO COMMUNITY PROVIDER NETWORK, INC.",
        "enumeration_date": "2016-02-05",
        "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": "60135131",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "STRIDE CHC - Jefferson Plaza Family Health at Jefferson Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Metro Community Provider Network, Inc. (STRIDE CHC - Alameda High School)
• Metro Community Provider Network, Inc. (STRIDE CHC - Jefferson Plaza Family Health Dental Clinic)
• Metro Community Provider Network, Inc. (STRIDE CHC - Alameda High School Dental Clinic)
• Metro Community Provider Network, Inc. (STRIDE CHC - Jefferson Plaza Behavioral Health at Jefferson Center)
• Metro Community Provider Network, Inc. (STRIDE CHC - Rose Stein Elementary School Behavioral Health)
• Metropolitan Pathologists PC
• Metrowest Eye Associates, P.C. (Black Diamond Eye Care)

• Federally Qualified Health Center (FQHC) in Lakewood, CO
• Providers in Lakewood, CO by specialty
• Federally Qualified Health Center (FQHC) in Colorado

• 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.

Verify at the official NPI Registry.