Healthcare Provider Details

I. General information

NPI: 1396426870
Provider Name (Legal Business Name): HEALTHONE CLINIC SERVICES-SURGICAL SPECIALTIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2023
Last Update Date: 07/27/2023
Certification Date: 07/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4105 BRIARGATE PKWY STE 300
COLORADO SPRINGS CO
80920-3487
US

IV. Provider business mailing address

2000 HEALTH PARK DR
BRENTWOOD TN
37027-4692
US

V. Phone/Fax

Practice location:
  • Phone: 303-225-8120
  • Fax:
Mailing address:
  • Phone: 615-373-7406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS WADLINGTON
Title or Position: VICE PRESIDENT
Credential:
Phone: 615-372-7332