Healthcare Provider Details

I. General information

NPI: 1275749350
Provider Name (Legal Business Name): TOXICOLOGY ASSOCIATES PROF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 10/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 S DOWNING ST SUITE 260
DENVER CO
80210-5855
US

IV. Provider business mailing address

2555 S DOWNING ST SUITE 260
DENVER CO
80210-5855
US

V. Phone/Fax

Practice location:
  • Phone: 303-765-3800
  • Fax: 303-765-3804
Mailing address:
  • Phone: 303-765-3800
  • Fax: 303-765-3804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number22473
License Number StateCO

VIII. Authorized Official

Name: SU DIERBECK
Title or Position: ADMINISTRATOR
Credential:
Phone: 303-765-3800