Healthcare Provider Details

I. General information

NPI: 1952796484
Provider Name (Legal Business Name): BURN AND RECONSTRUCTIVE CENTERS OF COLORADO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2015
Last Update Date: 10/11/2022
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E HAMPDEN AVE STE 310
ENGLEWOOD CO
80113-2769
US

IV. Provider business mailing address

PO BOX 12330
AUGUSTA GA
30914-2330
US

V. Phone/Fax

Practice location:
  • Phone: 706-863-9595
  • Fax: 706-447-7179
Mailing address:
  • Phone: 706-863-9595
  • Fax: 706-447-7179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: SHAWN FAGAN
Title or Position: OWNER/MD
Credential:
Phone: 706-863-9595