Healthcare Provider Details

I. General information

NPI: 1003859836
Provider Name (Legal Business Name): PINEY CREEK MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 10/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16728 E SMOKY HILL RD
AURORA CO
80015-2400
US

IV. Provider business mailing address

3464 S WILLOW ST SUITE 198
DENVER CO
80231-4531
US

V. Phone/Fax

Practice location:
  • Phone: 303-766-1006
  • Fax:
Mailing address:
  • Phone: 303-755-2900
  • Fax: 303-755-0404

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: MICHAEL G RATLIFF
Title or Position: PRESIDENT
Credential: DO
Phone: 303-766-1006