Provider Demographics
NPI:1053526541
Name:BROOMFIELD PEDIATRICS PLLC
Entity type:Organization
Organization Name:BROOMFIELD PEDIATRICS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:KREMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-438-5522
Mailing Address - Street 1:3301 W 144TH AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80023
Mailing Address - Country:US
Mailing Address - Phone:303-438-5522
Mailing Address - Fax:303-438-5686
Practice Address - Street 1:3301 W 144TH AVE
Practice Address - Street 2:STE 200
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80023
Practice Address - Country:US
Practice Address - Phone:303-438-5522
Practice Address - Fax:303-438-5686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO35049208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01350495Medicaid
CO01350495Medicaid