Healthcare Provider Details

I. General information

NPI: 1750759403
Provider Name (Legal Business Name): MEDNET COLORADO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2015
Last Update Date: 10/05/2024
Certification Date: 10/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11640 TELLER ST STE D
BROOMFIELD CO
80020-6945
US

IV. Provider business mailing address

11640 TELLER ST STE D
BROOMFIELD CO
80020-6945
US

V. Phone/Fax

Practice location:
  • Phone: 720-295-3145
  • Fax: 970-541-0099
Mailing address:
  • Phone: 720-295-3145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DON BURRIS
Title or Position: OWNER
Credential:
Phone: 303-887-4138