Healthcare Provider Details

I. General information

NPI: 1154807055
Provider Name (Legal Business Name): CO PACS 2 PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2018
Last Update Date: 07/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 SPRING ST
MORRISON CO
80465-2532
US

IV. Provider business mailing address

265 BROOKVIEW CENTRE WAY STE 400
KNOXVILLE TN
37919-4052
US

V. Phone/Fax

Practice location:
  • Phone: 865-693-1000
  • Fax:
Mailing address:
  • Phone: 865-693-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: DARIN RENTZ
Title or Position: OWNER / PRESIDENT
Credential: DO
Phone: 865-693-1000