Healthcare Provider Details

I. General information

NPI: 1063331296
Provider Name (Legal Business Name): HEALTHONE CLINIC SERVICES - PEDIATRIC SPECIALTIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E 19TH AVE STE 3550
DENVER CO
80218-1285
US

IV. Provider business mailing address

2000 HEALTH PARK DR
BRENTWOOD TN
37027-4525
US

V. Phone/Fax

Practice location:
  • Phone: 303-790-1515
  • Fax:
Mailing address:
  • Phone: 615-373-7406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: THOMAS FENDER
Title or Position: VICE PRESIDENT
Credential:
Phone: 303-584-8111