Healthcare Provider Details

I. General information

NPI: 1154957611
Provider Name (Legal Business Name): HEALTHONE CLINIC SERVICES - OTOLARYNGOLOGY SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2020
Last Update Date: 03/17/2020
Certification Date: 03/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 S POTOMAC ST
AURORA CO
80012-5411
US

IV. Provider business mailing address

2000 HEALTH PARK DR
BRENTWOOD TN
37027-4525
US

V. Phone/Fax

Practice location:
  • Phone: 303-695-2600
  • Fax:
Mailing address:
  • Phone: 615-372-5426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM M SMITHAM
Title or Position: VICE PRESIDENT
Credential:
Phone: 303-584-8119