Healthcare Provider Details

I. General information

NPI: 1790713402
Provider Name (Legal Business Name): FRANK SCALISE PAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 03/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 BROADWAY STOUT STREET CLINIC
DENVER CO
80205-2526
US

IV. Provider business mailing address

2111 CHAMPA ST
DENVER CO
80205-2529
US

V. Phone/Fax

Practice location:
  • Phone: 303-293-2220
  • Fax: 303-293-3977
Mailing address:
  • Phone: 303-293-2220
  • Fax: 303-293-3977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0240
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: