Healthcare Provider Details

I. General information

NPI: 1548726599
Provider Name (Legal Business Name): OMG SPECIALTY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2019
Last Update Date: 06/23/2020
Certification Date: 06/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2352 MEADOWS BLVD STE 255
CASTLE ROCK CO
80109-8417
US

IV. Provider business mailing address

1805 SHEA CENTER DR STE 301
HIGHLANDS RANCH CO
80129-2277
US

V. Phone/Fax

Practice location:
  • Phone: 303-738-1100
  • Fax: 303-738-1310
Mailing address:
  • Phone: 303-359-2557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: KATIE LENNON
Title or Position: DIRECTOR, INTEGRATION
Credential:
Phone: 303-738-1100