Organization
FRONT RANGE CLINIC INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CLARK MCCOY MD (PRESIDENT)
(352) 214-7180
Entity
Organization
Contact information
Practice address
8223 W 20TH ST STE 100A, GREELEY, CO 80634-3036
(970) 702-2705
(970) 639-4475
Mailing address
1040 E ELIZABETH ST STE C, FORT COLLINS, CO 80524-3952
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
0054001
CO
207QA0401X
Addiction Medicine (Family Medicine) Physician
Primary
0051001
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1598135451
—
CO
Enumeration date
08/17/2017
Last updated
02/09/2021
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