Healthcare Provider Details

I. General information

NPI: 1659290062
Provider Name (Legal Business Name): SMPA MEDICAL ONE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2026
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10622 RACINE ST
COMMERCE CITY CO
80022-6635
US

IV. Provider business mailing address

10622 RACINE ST
COMMERCE CITY CO
80022-6635
US

V. Phone/Fax

Practice location:
  • Phone: 303-503-3980
  • Fax:
Mailing address:
  • Phone: 303-503-3980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SHANE EUGENE MASS
Title or Position: MANAGING MEMBER
Credential: DMSC, MPA, PA-C
Phone: 303-503-3980