Healthcare Provider Details

I. General information

NPI: 1871104604
Provider Name (Legal Business Name): HEALTHONE CLINIC SERVICES-SURGICAL SPECIALTIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2020
Last Update Date: 08/14/2020
Certification Date: 08/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3425 S CLARKSON ST
ENGLEWOOD CO
80113-2811
US

IV. Provider business mailing address

2000 HEALTH PARK DR
BRENTWOOD TN
37027-4525
US

V. Phone/Fax

Practice location:
  • Phone: 303-209-2503
  • Fax:
Mailing address:
  • Phone: 615-372-5426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM M SMITHAM
Title or Position: VICE PRESIDENT
Credential:
Phone: 303-584-8119