Healthcare Provider Details

I. General information

NPI: 1659988616
Provider Name (Legal Business Name): 5280 MEDICAL CONCIERGE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2020
Last Update Date: 01/22/2021
Certification Date: 01/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10050 RALSTON RD STE 1
ARVADA CO
80004-4974
US

IV. Provider business mailing address

2902 OAK ST
LAKEWOOD CO
80215-7161
US

V. Phone/Fax

Practice location:
  • Phone: 515-447-3582
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ELLIE TITARENKO
Title or Position: OWNER, AUTHORIZED OFFICIAL
Credential:
Phone: 720-583-6145