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NPI Code Detail

MEDICARE: OMG SPECIALTY CARE LLC

MEDICARE: OMG SPECIALTY CARE 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
1207V00000XObstetrics & Gynecology Physician

General Provider Information

NPI Number : 1548726599
Entity Type Code : Organization
Provider Name (Legal Business Name) : OMG SPECIALTY CARE LLC
Provider Business Mailing Address
First Line : 1805 SHEA CENTER DR STE 301
Second Line :
City : HIGHLANDS RANCH
State : CO
Zip : 80129-2277
Country : US
Telephone Number : 303-359-2557
Fax Number :
Provider Business Practice Location Address
First Line : 2352 MEADOWS BLVD STE 255
Second Line :
City : CASTLE ROCK
State : CO
Zip : 80109-8417
Country : US
Telephone Number : 303-738-1100
Fax Number : 303-738-1310
Authorized Official
Title or Position : DIRECTOR, INTEGRATION
Name : KATIE LENNON
Credential :
Telephone Number : 303-738-1100
Provider Enumeration Date : 02/14/2019
Last Update Date : 06/23/2020

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Directions to “OMG SPECIALTY CARE LLC ” Practice Location

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