Healthcare Provider Details

I. General information

NPI: 1346057981
Provider Name (Legal Business Name): HEALTHONE CLINIC SERVICES - PEDIATRIC SPECIALTIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2024
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10099 RIDGEGATE PKWY STE 300
LONE TREE CO
80124-5534
US

IV. Provider business mailing address

2000 HEALTH PARK DR
BRENTWOOD TN
37027-4692
US

V. Phone/Fax

Practice location:
  • Phone: 303-560-9933
  • Fax:
Mailing address:
  • Phone: 615-373-7406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS F WADLINGTON
Title or Position: VICE PRESIDENT
Credential:
Phone: 972-401-9807