Healthcare Provider Details

I. General information

NPI: 1164003257
Provider Name (Legal Business Name): CHANGING TIMES MEDICAL TECHNOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2021
Last Update Date: 03/01/2022
Certification Date: 03/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 S PARKER RD STE 208
DENVER CO
80231-2119
US

IV. Provider business mailing address

1230 S PARKER RD STE 208
DENVER CO
80231-2119
US

V. Phone/Fax

Practice location:
  • Phone: 720-404-0424
  • Fax: 303-955-5963
Mailing address:
  • Phone: 303-593-1595
  • Fax: 303-955-5963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GWENDOLYNE THORNTON
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 303-593-1595