Healthcare Provider Details

I. General information

NPI: 1306501903
Provider Name (Legal Business Name): SIRIUS HEALTHCARE MANAGEMENT INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2021
Last Update Date: 11/08/2021
Certification Date: 11/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11640 TELLER ST
BROOMFIELD CO
80020-6907
US

IV. Provider business mailing address

11640 TELLER ST
BROOMFIELD CO
80020-6907
US

V. Phone/Fax

Practice location:
  • Phone: 303-817-7665
  • Fax:
Mailing address:
  • Phone: 303-817-7665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: BENJAMIN FUCHS
Title or Position: CEO
Credential: R.PH.
Phone: 303-817-7665