Healthcare Provider Details

I. General information

NPI: 1194246058
Provider Name (Legal Business Name): ASCENT MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2017
Last Update Date: 07/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5375 W 73RD PLACE
WESTMINSTER CO
80003
US

IV. Provider business mailing address

757 E 20TH AVE SUITE 370 #831
DENVER CO
80205
US

V. Phone/Fax

Practice location:
  • Phone: 720-372-6751
  • Fax: 303-362-6615
Mailing address:
  • Phone: 303-362-6615
  • Fax: 720-372-6751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: JILLIAN JULIANO CONDER
Title or Position: CO-OWNER
Credential: CNIM
Phone: 615-438-0065