Healthcare Provider Details

I. General information

NPI: 1114502937
Provider Name (Legal Business Name): MOBILE HEALTH TECHNOLOGY WITH SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2021
Last Update Date: 04/23/2021
Certification Date: 04/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12150 ANDREWS DR
DENVER CO
80239-4441
US

IV. Provider business mailing address

PO BOX 2621
MONUMENT CO
80132-2621
US

V. Phone/Fax

Practice location:
  • Phone: 720-449-6616
  • Fax: 720-792-3458
Mailing address:
  • Phone: 720-449-6616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SUZAN L PERREAULT
Title or Position: PRINCIPAL
Credential:
Phone: 720-449-6166