Healthcare Provider Details

I. General information

NPI: 1053882688
Provider Name (Legal Business Name): INJURY CARE ASSOCIATES THORNTON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2018
Last Update Date: 12/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9351 GRANT ST STE 600
THORNTON CO
80229-4373
US

IV. Provider business mailing address

2490 W 26TH AVE STE 5A
DENVER CO
80211-5300
US

V. Phone/Fax

Practice location:
  • Phone: 303-531-4144
  • Fax: 303-531-4145
Mailing address:
  • Phone: 303-531-4144
  • Fax: 303-531-4145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY BRETT DE MOOY
Title or Position: PRESIDENT
Credential:
Phone: 303-531-4144