=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134718414
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VEROS CLINICAL SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/12/2021
-----------------------------------------------------
Last Update Date | 02/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6801 S YOSEMITE ST
-----------------------------------------------------
City | CENTENNIAL
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80112-1406
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-225-0080
-----------------------------------------------------
Fax | 303-487-9103
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6801 S YOSEMITE ST
-----------------------------------------------------
City | CENTENNIAL
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80112-1406
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-209-1819
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF MEDICAL OFFICER
-----------------------------------------------------
Name | DR. ISAAC R. MELAMED
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 303-773-9000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------