Healthcare Provider Details

I. General information

NPI: 1801701982
Provider Name (Legal Business Name): GRAVPHYR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 N GRANT ST # 1441
DENVER CO
80203-1859
US

IV. Provider business mailing address

1500 N GRANT ST # 1441
DENVER CO
80203-1859
US

V. Phone/Fax

Practice location:
  • Phone: 406-309-6462
  • Fax:
Mailing address:
  • Phone: 406-309-6462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANNIE MOORE
Title or Position: OWNER
Credential:
Phone: 406-309-6462