Healthcare Provider Details

I. General information

NPI: 1104385558
Provider Name (Legal Business Name): JEREMY JAMES SA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2019
Last Update Date: 06/06/2023
Certification Date: 06/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 W HAMPDEN PL STE 250
ENGLEWOOD CO
80110-2471
US

IV. Provider business mailing address

8490 E CRESCENT PKWY STE 380
GREENWOOD VILLAGE CO
80111-2815
US

V. Phone/Fax

Practice location:
  • Phone: 720-508-8855
  • Fax: 303-777-8377
Mailing address:
  • Phone: 303-957-1310
  • Fax: 303-761-4252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: