Healthcare Provider Details

I. General information

NPI: 1831939743
Provider Name (Legal Business Name): OMG SPECIALTY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2024
Last Update Date: 05/29/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7780 S BROADWAY STE 280
LITTLETON CO
80122-2633
US

IV. Provider business mailing address

1805 SHEA CENTER DR STE 450
HIGHLANDS RANCH CO
80129-2255
US

V. Phone/Fax

Practice location:
  • Phone: 303-738-1100
  • Fax: 303-738-1310
Mailing address:
  • Phone: 303-357-2559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: KARIN WHITEHEAD
Title or Position: DIRECTOR
Credential:
Phone: 303-357-2559