Healthcare Provider Details

I. General information

NPI: 1780046706
Provider Name (Legal Business Name): AMERICA GARDEN NEUROSCIENCES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2016
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4450 UNION ST STE 200
JOHNSTOWN CO
80534-2865
US

IV. Provider business mailing address

4450 UNION ST STE 200
JOHNSTOWN CO
80534-2865
US

V. Phone/Fax

Practice location:
  • Phone: 970-315-4018
  • Fax: 970-315-5554
Mailing address:
  • Phone: 970-315-4018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: CANDACE PALUMBO
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 970-315-4018