Healthcare Provider Details

I. General information

NPI: 1295592723
Provider Name (Legal Business Name): 4344 WOODLANDS BLVD 240 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2024
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4344 WOODLANDS BLVD STE 240
CASTLE ROCK CO
80104-2801
US

IV. Provider business mailing address

4344 WOODLANDS BLVD STE 240
CASTLE ROCK CO
80104-2801
US

V. Phone/Fax

Practice location:
  • Phone: 720-408-9118
  • Fax: 720-547-9180
Mailing address:
  • Phone: 720-408-9118
  • Fax: 720-547-9180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name: ALLISON HEGARTY
Title or Position: PRACTICE MANAGER
Credential:
Phone: 720-408-9118