Healthcare Provider Details

I. General information

NPI: 1891424420
Provider Name (Legal Business Name): MKBS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2022
Last Update Date: 06/08/2022
Certification Date: 05/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5909 E 38TH AVE
DENVER CO
80207-1252
US

IV. Provider business mailing address

5909 E 38TH AVE
DENVER CO
80207-1252
US

V. Phone/Fax

Practice location:
  • Phone: 303-336-9132
  • Fax:
Mailing address:
  • Phone: 303-336-9132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number State

VIII. Authorized Official

Name: LAURA EWELL
Title or Position: ACCOUNTING MANAGER
Credential:
Phone: 303-336-9000