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General NPI Number Information
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NPI Number | 1275943201
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Entity Type | Organization
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Legal Business Name | MSK MEDICAL LLC
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Dates
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Enumeration Date | 04/29/2014
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Last Update Date | 04/29/2014
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Provider Practice Location Address
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Address Line | 1 BROADWAY A-100
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City | DENVER
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State | CO
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Zip | 80203-3959
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Country | US
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Telephone | 303-455-6345
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Fax | 303-455-6343
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Provider Business Mailing Address
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Address Line | 1 BROADWAY A-100
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City | DENVER
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State | CO
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Zip | 80203-3959
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Country | US
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Telephone | 303-455-6345
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Fax | 303-455-6343
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Authorized Official
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Title or Position | OWNER
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Name | W RAFER LEACH
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Credential | M.D.
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Telephone | 303-870-8870
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 38790
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License Number State | CO
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