Healthcare Provider Details

I. General information

NPI: 1033526355
Provider Name (Legal Business Name): NCALDWELL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2014
Last Update Date: 04/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1338 PHAY AVE
CANON CITY CO
81212-2302
US

IV. Provider business mailing address

840 S WOODRIDGE RD
FRANKTOWN CO
80116-8790
US

V. Phone/Fax

Practice location:
  • Phone: 702-453-3799
  • Fax: 702-453-5741
Mailing address:
  • Phone: 702-453-3799
  • Fax: 702-453-5741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDR.0051221
License Number StateCO

VIII. Authorized Official

Name: NICOLE CALDWELL
Title or Position: OWNER
Credential: M.D.
Phone: 307-763-7702