Healthcare Provider Details

I. General information

NPI: 1205467842
Provider Name (Legal Business Name): TARA HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2020
Last Update Date: 11/19/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 WAZEE ST APT 301
DENVER CO
80202-5952
US

IV. Provider business mailing address

1441 WAZEE STREET 301
DENVER CO
80202-1625
US

V. Phone/Fax

Practice location:
  • Phone: 800-935-2305
  • Fax: 747-999-8827
Mailing address:
  • Phone:
  • Fax: 747-999-8827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code246Y00000X
TaxonomyHealth Information Specialist/Technologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code246YC3302X
TaxonomyPhysician Office Based Coding Specialist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MARCUS HANSEN
Title or Position: CEO
Credential:
Phone: 970-560-3659