Provider Demographics
NPI:1679554919
Name:CENTENNIAL VALLEY PEDIATRICS, P.C.
Entity type:Organization
Organization Name:CENTENNIAL VALLEY PEDIATRICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:BS, MHS
Authorized Official - Phone:303-666-7337
Mailing Address - Street 1:400 SOUTH MCCASLIN BOULDEVARD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027
Mailing Address - Country:US
Mailing Address - Phone:303-666-7337
Mailing Address - Fax:303-666-7379
Practice Address - Street 1:400 SOUTH MCCASLIN BOULDEVARD
Practice Address - Street 2:SUITE 103
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-8002
Practice Address - Country:US
Practice Address - Phone:303-666-7337
Practice Address - Fax:303-666-7379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty