Healthcare Provider Details

I. General information

NPI: 1205283629
Provider Name (Legal Business Name): FOOTHILLS INTEGRATED HEALTH SYSTEMS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2016
Last Update Date: 06/03/2020
Certification Date: 06/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7761 SHAFFER PKWY STE 225
LITTLETON CO
80127-3729
US

IV. Provider business mailing address

6241 W ARBOR AVE
LITTLETON CO
80123-3822
US

V. Phone/Fax

Practice location:
  • Phone: 303-862-1504
  • Fax: 303-933-9431
Mailing address:
  • Phone: 303-720-9369
  • Fax: 303-933-9431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR.0051221
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0992915-NP
License Number StateCO

VIII. Authorized Official

Name: DR. DARCY KOEHN
Title or Position: PRESIDENT
Credential: DC, FNP
Phone: 37-209-3693