1235336173 NPI number — HEALTHONE CLINIC SERVICES NEUROSCIENCES LLC

Table of content: (NPI 1235336173)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235336173 NPI number — HEALTHONE CLINIC SERVICES NEUROSCIENCES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTHONE CLINIC SERVICES NEUROSCIENCES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235336173
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/08/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4900 S MONACO ST
Provider Second Line Business Mailing Address:
#210
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80237-3486
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-584-8000
Provider Business Mailing Address Fax Number:
303-584-8141

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4900 S MONACO ST
Provider Second Line Business Practice Location Address:
#210
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80237-3486
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-584-8000
Provider Business Practice Location Address Fax Number:
303-584-8141
Provider Enumeration Date:
07/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
EVANS
Authorized Official First Name:
TODD
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
303-584-8000

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1235336173 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 98259733 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 28979826 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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