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General NPI Number Information
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NPI Number | 1003859836
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Entity Type | Organization
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Legal Business Name | PINEY CREEK MEDICAL LLC
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Dates
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Enumeration Date | 06/13/2006
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Last Update Date | 10/31/2007
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Provider Practice Location Address
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Address Line | 16728 E SMOKY HILL RD
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City | AURORA
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State | CO
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Zip | 80015-2400
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Country | US
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Telephone | 303-766-1006
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Fax |
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Provider Business Mailing Address
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Address Line | 3464 S WILLOW ST SUITE 198
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City | DENVER
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State | CO
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Zip | 80231-4531
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Country | US
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Telephone | 303-755-2900
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Fax | 303-755-0404
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL G RATLIFF
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Credential | DO
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Telephone | 303-766-1006
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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