Healthcare Provider Details

I. General information

NPI: 1366904443
Provider Name (Legal Business Name): VACCINE HIPPO CO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2019
Last Update Date: 04/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 UNION BLVD STE 311
LAKEWOOD CO
80228-1831
US

IV. Provider business mailing address

10040 W CHEYENNE AVE STE 170-146
LAS VEGAS NV
89129-7719
US

V. Phone/Fax

Practice location:
  • Phone: 866-829-2968
  • Fax:
Mailing address:
  • Phone: 702-641-1776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CHAD COLUMBUS
Title or Position: PRESIDENT
Credential:
Phone: 866-829-2968