METRO COMMUNITY PROVIDER NETWORK, INC. (NPI# 1114213972) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114213972 |
| Entity Type | Organization |
| Organization Name | METRO COMMUNITY PROVIDER NETWORK, INC. |
| Other Organization Name | STRIDE CHC - UNION SQUARE HEALTH PLAZA AT JEFFERSON CENTER |
| Practice Address |
12055 West 2nd Place Lakewood CO 80228-1506 |
| Mailing Address |
2255 S Oneida St Denver CO 80224-2522 |
| Practice Telephone | 3037897072 |
| Practice Fax Number | 3037897074 |
| Mailing Telephone | 3033606276 |
| Mailing Fax Number | 3037612787 |
| Enumeration Date | 2011-06-21 |
| Last Update Date | 2020-03-10 |
| Authorized Official Name | BEN R. WIEDERHOLT (PRESIDENT AND CEO) |
| Authorized Official Telephone | 3037611977 |
| Is Organization Subpart | Y |
| Parent Organization Name | METRO COMMUNITY PROVIDER NETWORK, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
CO | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CO | 86602373 | 05 |
| Other Name | Type Code |
|---|---|
| STRIDE CHC - Union Square Health Plaza at Jefferson Center | Doing Business As Name - Organization |
| STRIDE CHC-Union Square Plaza at Jefferson Center for Mental Health | Doing Business As Name - Organization |
| Union Square Plaza at Jefferson Center for Mental Health | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861014805 | Metro Community Provider Network, Inc. | Clinic/Center | 3595 S Teller St Fl 4, Lakewood, CO 80235-2014 | 2020-05-13 |
| 1033755392 | Metro Community Provider Network, Inc. | Clinic/Center | 12055 W 2nd Pl # 200, Lakewood, CO 80228-1506 | 2019-11-21 |
| 1952853772 | Metro Community Provider Network, Inc. | Clinic/Center | 6303 Wadsworth Bypas, Arvada, CO 80003 | 2016-10-27 |
| 1679931646 | Metro Community Provider Network, Inc. | Clinic/Center | 3595 South Teller Street, Lakewood, CO 80235-2014 | 2016-02-05 |
| 1558727883 | Metro Community Provider Network, Inc. | Clinic/Center | 10680 Del Mar Parkway, Aurora, CO 80010-4011 | 2015-12-31 |
| 1649605536 | Metro Community Provider Network, Inc. | Clinic/Center | 1537 Alton Street, Aurora, CO 80010-1712 | 2013-09-10 |
| 1811333842 | Metro Community Provider Network, Inc. | Clinic/Center | 1666 Elmira Street, Aurora, CO 80110-2122 | 2013-05-16 |
| 1184961492 | Metro Community Provider Network, Inc. | Clinic/Center | 7495 West 29th Avenue, Wheat Ridge, CO 80033-8002 | 2013-01-07 |
| 1568707776 | Metro Community Provider Network, Inc. | Clinic/Center | 15501 East 13th Avenue, Aurora, CO 80011-7203 | 2012-11-29 |
| 1558657312 | Metro Community Provider Network, Inc. | Clinic/Center | 791 Chambers Rd Ste 220, Aurora, CO 80011-7112 | 2011-06-21 |
| Street Address |
12055 WEST 2ND PLACE |
| City | LAKEWOOD |
| State | CO |
| Zip Code | 80228-1506 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174083570 | Lindsey Mae Beverly | Physician Assistant | Medical Plaza 2, 11700 W 2nd Pl, #350, Lakewood, CO 80228 | 2019-03-21 |
| 1881119931 | Cory J Frazier | Nurse Practitioner | 11600 W. 2nd Pl, Lakewood, CO 80228 | 2017-08-10 |
| 1508213885 | Chelsea Tucker | Counselor | 12157 W Cedar Dr Ste 207, Lakewood, CO 80228 | 2016-05-17 |
| 1972963841 | Shastin Gerbracht | Counselor | 12055 W 2nd Pl, Ste 200, Lakewood, CO 80228 | 2016-03-04 |
| 1073983375 | Suzanne Phillips | Behavioral Analyst | 200 Union Blvd. Ste. 200, Lakewood, Co. 80228, Denver, CO 80228 | 2015-09-29 |
| 1700265667 | April Mearsha | Doula | 12977 W Cedar Dr, 2-305, Lakewood, CO 80228 | 2015-05-26 |
| 1306233713 | Caleb Hedberg | Internal Medicine | 165 S Union Blvd Ste 800, Lakewood, CO 80228 | 2015-04-23 |
| 1972996288 | David Lindsey Currie | Counselor | 12055 W 2nd Place, Jefferson Ctr for Mental Health, Lakewood, CO 80228 | 2015-03-11 |
| 1619365533 | Michelle Broberg II | Technician | 12055 West 2nd Plaza, Lakewood, CO 80228 | 2014-12-30 |
| 1750789012 | Kayla Morrison | Social Worker | 12005 W 2nd Place, Lakewood, CO 80228 | 2014-12-18 |
| Find all providers in zip 80228 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861014805 | Metro Community Provider Network, Inc. | Clinic/Center | 3595 S Teller St Fl 4, Lakewood, CO 80235-2014 | 2020-05-13 |
| 1033755392 | Metro Community Provider Network, Inc. | Clinic/Center | 12055 W 2nd Pl # 200, Lakewood, CO 80228-1506 | 2019-11-21 |
| 1518437474 | Lakewood Resource and Referral Center, Inc. | Clinic/Center | 485 Locust St, Lakewood, NJ 08701-5896 | 2018-12-04 |
| 1679931646 | Metro Community Provider Network, Inc. | Clinic/Center | 3595 South Teller Street, Lakewood, CO 80235-2014 | 2016-02-05 |
| 1558526418 | Metro Community Provider Network, Inc. | Clinic/Center | 8755 West 14th Avenue, Lakewood, CO 80215-4863 | 2008-07-21 |
| 1437314481 | Metro Community Provider Network, Inc. | Clinic/Center | 1255 South Wadsworth Blvd., Lakewood, CO 80232-5406 | 2008-07-18 |
| 1992965420 | Metro Community Provider Network, Inc. | Clinic/Center | 8500 West Colfax Avenue, Lakewood, CO 80215-4011 | 2008-06-09 |
| 1699778233 | The Lakes Community Health Center, Inc | Clinic/Center | 15397 State Highway 32, Lakewood, WI 54138-9702 | 2005-05-27 |
| 1710980917 | Ocean Health Initiatives | Clinic/Center | 101 2nd St, Lakewood, NJ 08701-3324 | 2005-05-23 |
| 1447873773 | Metro Community Provider Network, Inc. | Clinic/Center | 3595 S Teller St Fl 4, Lakewood, CO 80235-2014 | 2020-05-21 |
| Find all providers in LAKEWOOD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.