DESTINATION DERMATOLOGY LLC (NPI# 1205368453) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205368453 |
| Entity Type | Organization |
| Organization Name | DESTINATION DERMATOLOGY LLC |
| Other Organization Name | RENEW DERMATOLOGY |
| Practice Address |
60 Main Street Ste F, G & H Frisco CO 80443 |
| Mailing Address |
265 Dillon Ridge Rd Ste C402 Dillon CO 80435-6009 |
| Practice Telephone | 3092871909 |
| Mailing Telephone | 3092871909 |
| Enumeration Date | 2017-03-28 |
| Last Update Date | 2017-03-28 |
| Authorized Official Name | KELLY BALLOU (MANAGING MEMBER) |
| Authorized Official Telephone | 3092871909 |
| Authorized Official Credential | PA-C |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM2500X |
Clinic/Center Specialization: Medical Specialty |
PA0004388 | CO | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Renew Dermatology | Doing Business As Name - Organization |
| Street Address |
60 MAIN STREET STE F, G & H |
| City | FRISCO |
| State | CO |
| Zip Code | 80443 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447583216 | Valerie Fagan | Massage Therapist | 60 Main Street, Suite H, Frisco, CO 80443 | 2009-09-11 |
| 1366467805 | Kelly Ballou | Physician Assistant | 60 Main Street, Ste F,g,h Beaver Plaza Condo, Frisco, CO 80443 | 2006-07-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487254215 | Sheridan Childrens Healthcare Services of Colorado PC | Pediatrics | 340 Peak Oned Drive, Frisco, CO 80443 | 2020-10-30 |
| 1073139267 | Colorado Mountain Medical, LLC | Internal Medicine | 323 West Main Street, Suite 101, Frisco, CO 80443 | 2020-06-23 |
| 1720611882 | Michael Shanser | Counselor | 101 West Main Suite 301, Frisco, CO 80443 | 2020-02-18 |
| 1407499205 | Kerri Hudgins | Dental Hygienist | 360 Peak One Drive, Suite 325, # 4337, Frisco, CO 80443 | 2019-10-24 |
| 1134762123 | Catholic Health Initiatives Colorado | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 360 Peak One Blvd, Ste 390, Frisco, CO 80443 | 2019-10-22 |
| 1881241172 | Shannon Maser | Chiropractor | 117 S. 6th Ave, Unit 2, Frisco, CO 80443 | 2019-08-21 |
| 1508421785 | Juli M Joyce | Preventive Medicine | 360 Peak One Dr #230, Frisco, CO 80443 | 2019-05-03 |
| 1194288449 | Sara Christian Broughton | Peer Specialist | 360 Peak One Dr Ste 130, Frisco, CO 80443 | 2019-04-12 |
| 1093275299 | Atis Spuris | Peer Specialist | 360 Peak One Dr Ste 140, Frisco, CO 80443 | 2019-03-22 |
| 1427520469 | Claire Melissa Mann | Nurse Practitioner | 984 Ten Mile Dr., Suite 3, Frisco, CO 80443 | 2018-12-31 |
| Find all providers in zip 80443 | ||||
| Taxonomy Code | 261QM2500X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Medical Specialty |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer). |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447542816 | Mjm Chiropractic Inc | Clinic/Center | 7500 Stonebrook Pkwy, Suite 103, Frisco, TX 75034-5377 | 2011-05-04 |
| 1467524678 | Stacy L. Terry, Md Pa | Clinic/Center | 4820 Star Ridge Ln, Frisco, TX 75034-5128 | 2006-11-14 |
| 1922002674 | Frisco Medical Center LLP | Clinic/Center | 5601 Warren Pkwy, Frisco, TX 75034-4069 | 2005-06-10 |
| 1487009643 | Freedom Total Wellness | Clinic/Center | 3550 Parkwood Blvd Ste 103, Frisco, TX 75034-1904 | 2016-04-25 |
| 1528223609 | Vision Works Eyecare, P.a. | Clinic/Center | 6842 Lebanon Road, Suite 101, Frisco, TX 75034-7480 | 2008-07-28 |
| 1396938593 | Dr Kristen Innes | Clinic/Center | 3880 Parkwood Blvd, Suite 403, Frisco, TX 75034-1928 | 2007-08-21 |
| 1497971766 | Back and Body PC | Clinic/Center | 2995 Preston Rd, Suite 1550, Frisco, TX 75034-0602 | 2007-04-17 |
| 1427162122 | Frisco Dermatology Associates | Clinic/Center | 3880 Parkwood Blvd, Suite 102, Frisco, TX 75034-1928 | 2006-08-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558977058 | Yampa Valley Medical Center | Clinic/Center | 940 Central Park Dr Ste 191, Steamboat Springs, CO 80487-8853 | 2020-09-20 |
| 1932713153 | Scl Health Medical Group - Denver, LLC | Clinic/Center | 11900 Grant St Ste 240, Northglenn, CO 80233-1117 | 2020-09-04 |
| 1508470998 | Scl Health Medical Group - Denver, LLC | Clinic/Center | 1960 N Ogden St Ste 520, Denver, CO 80218-3671 | 2020-09-02 |
| 1346865896 | Boulder Community Health | Clinic/Center | 4743 Arapahoe Ave Ste 201c, Boulder, CO 80303-1128 | 2020-06-10 |
| 1346872843 | Nephrology Clinic PC | Clinic/Center | 8229 W 20th St, Greeley, CO 80634-3040 | 2020-02-12 |
| 1023640513 | Nephrology Clinic PC | Clinic/Center | 2988 Ginnala Dr, Loveland, CO 80538-2701 | 2020-02-12 |
| 1457991473 | Boulder Community Health | Clinic/Center | 101 Erie Pkwy Ste 201f, Erie, CO 80516-4072 | 2020-01-07 |
| 1922659044 | Boulder Community Health | Clinic/Center | 4880 Riverbend Rd Ste 100, Boulder, CO 80301-2622 | 2019-09-20 |
| 1225687965 | Boulder Community Health | Clinic/Center | 4747 Arapahoe Ave, 3 West, Boulder, CO 80303-1131 | 2019-09-05 |
| 1538716923 | Boulder Community Health | Clinic/Center | 101 Erie Pkwy Ste 201d, Erie, CO 80516-4072 | 2019-08-21 |
| Find all providers with the same taxonomy | ||||
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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.