NPIMap

Organization Active NPI

Front Range Clinic Inc.

  • Addiction Medicine (Family Medicine) Physician
  • Northglenn, CO
National Provider Identifier
1740706035
Registry record updated Dec 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction Medicine (Family Medicine) PhysicianTaxonomy code 207QA0401X
License
0054001 Issued in CO
Legal business name
FRONT RANGE CLINIC INC.
Practice address
11172 Huron St Ste 20
Northglenn, CO 80234-4380
Phone
(303) 568-9694
NPI assigned
Aug 17, 2017
Last updated
Dec 17, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2020

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 0054001 CO
Addiction Medicine (Family Medicine) Physician 207QA0401X 0054001 CO Primary

Addresses

Primary practice location

11172 Huron St Ste 20
Northglenn, CO 80234-4380

Mailing address

1040 E Elizabeth St Ste C
Fort Collins, CO 80524-3952
Phone (352) 214-7180

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

1040 E Elizabeth St
Ste C
Fort Collins, CO 80524

9025 Grant St
Ste 101
Thornton, CO 80229
Phone (303) 657-9117

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1502928000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1608163200000",
    "number": "1740706035",
    "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": "352-214-7180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11172 HURON ST STE 20",
            "city": "NORTHGLENN",
            "state": "CO",
            "postal_code": "802344380",
            "telephone_number": "303-568-9694"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRONT RANGE CLINIC INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-17",
        "last_updated": "2020-12-17",
        "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": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "0054001",
            "primary": false
        },
        {
            "code": "207QA0401X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Addiction Medicine",
            "state": "CO",
            "license": "0054001",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1598135451",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Northglenn, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 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.