MEDICARE: HEALTHONE CLINIC SERVICES - PEDIATRIC SPECIALTIES LLC

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	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1255946265
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHONE CLINIC SERVICES - PEDIATRIC SPECIALTIES LLC

Provider Business Mailing Address
First Line	:	2000 HEALTH PARK DR
Second Line	:
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-4525
Country	:	US
Telephone Number	:	615-372-5426
Fax Number	:

Provider Business Practice Location Address
First Line	:	1750 PIERCE ST
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80214-1434
Country	:	US
Telephone Number	:	303-238-6111
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	WILLIAM M SMITHAM
Credential	:
Telephone Number	:	303-584-8119

Provider Enumeration Date	:	09/15/2020
Last Update Date	:	09/15/2020

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