Healthcare Provider Details

I. General information

NPI: 1922462829
Provider Name (Legal Business Name): COLORADO INTEGRATED HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2016
Last Update Date: 04/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8216 S HOLLY ST
CENTENNIAL CO
80122-4012
US

IV. Provider business mailing address

300 S JACKSON ST STE 230
DENVER CO
80209-3131
US

V. Phone/Fax

Practice location:
  • Phone: 303-886-0121
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberDR.0035469
License Number StateCO

VIII. Authorized Official

Name: MIA SCOTT
Title or Position: OWNER
Credential: DO
Phone: 303-886-0121