MEDICARE: THRIVE MEDICAL GROUP INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM2800X	Methadone Clinic

General Provider Information

NPI Number	:	1194437814
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THRIVE MEDICAL GROUP INC

Provider Business Mailing Address
First Line	:	1487 S KENTON ST
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80012-4119
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3601 S BROADWAY
Second Line	:
City	:	ENGLEWOOD
State	:	CO
Zip	:	80113-3610
Country	:	US
Telephone Number	:	303-658-0059
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	SOLOMON BACHAYEV
Credential	:
Telephone Number	:	303-658-0059

Provider Enumeration Date	:	12/14/2022
Last Update Date	:	12/14/2022

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