Healthcare Provider Details

I. General information

NPI: 1942744784
Provider Name (Legal Business Name): INJURY CARE ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2016
Last Update Date: 12/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2490 W 26TH AVE SUITE A-5
DENVER CO
80211-5314
US

IV. Provider business mailing address

2490 W 26TH AVE SUITE A-5
DENVER CO
80211-5314
US

V. Phone/Fax

Practice location:
  • Phone: 303-531-4144
  • Fax: 303-531-4145
Mailing address:
  • Phone: 303-531-4144
  • Fax: 303-531-4145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number39176
License Number StateCO

VIII. Authorized Official

Name: ANTHONY BRETT DE MOOY
Title or Position: PRESIDENT
Credential:
Phone: 720-584-5827