Healthcare Provider Details

I. General information

NPI: 1629196324
Provider Name (Legal Business Name): METROPOLITAN STATE UNIVERSITY OF DENVER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 08/12/2022
Certification Date: 07/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 LAWRENCE WAY SUITE 150
DENVER CO
80204
US

IV. Provider business mailing address

PO BOX 173362 CB 20
DENVER CO
80217-3362
US

V. Phone/Fax

Practice location:
  • Phone: 303-615-9999
  • Fax: 720-778-5850
Mailing address:
  • Phone: 303-615-9999
  • Fax: 720-778-5850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberBM2052835
License Number StateDC

VIII. Authorized Official

Name: LISA LASSWELL
Title or Position: ASSISTANT DIRECTOR
Credential:
Phone: 303-615-1949