Healthcare Provider Details

I. General information

NPI: 1760468680
Provider Name (Legal Business Name): VA EASTERN COLORADO HCS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 02/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 CLERMONT ST LAB (113)
DENVER CO
80220-3808
US

IV. Provider business mailing address

1055 CLERMONT ST LAB (113)
DENVER CO
80220-3808
US

V. Phone/Fax

Practice location:
  • Phone: 303-399-8020
  • Fax: 303-393-4176
Mailing address:
  • Phone: 303-399-8020
  • Fax: 303-393-4176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: BARBARA C MAYERICK
Title or Position: DIRECTOR, BUSINESS DEVELOPMENT
Credential:
Phone: 202-254-0339