Healthcare Provider Details

I. General information

NPI: 1952819450
Provider Name (Legal Business Name): COLORADO SENIOR PROVIDER NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2018
Last Update Date: 03/10/2020
Certification Date: 03/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2221 E ARAPAHOE RD UNIT 3728
CENTENNIAL CO
80161-5079
US

IV. Provider business mailing address

PO BOX 3728
LITTLETON CO
80161-3728
US

V. Phone/Fax

Practice location:
  • Phone: 303-877-7239
  • Fax:
Mailing address:
  • Phone: 303-877-7239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberDR0027631
License Number StateCO

VIII. Authorized Official

Name: MARK TALMAGE
Title or Position: GENERAL PARTNER
Credential: MD
Phone: 303-877-7239