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General NPI Number Information
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NPI Number | 1306387410
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Entity Type | Organization
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Legal Business Name | BELLEVIEW SPINE AND WELLNESS PC
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Dates
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Enumeration Date | 03/09/2017
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Last Update Date | 03/22/2017
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Provider Practice Location Address
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Address Line | 5191 S YOSEMITE ST SUITE A
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City | GREENWOOD VILLAGE
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State | CO
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Zip | 80111-3305
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Country | US
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Telephone | 303-771-3102
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Fax |
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Provider Business Mailing Address
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Address Line | 5191 S YOSEMITE ST SUITE A
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City | GREENWOOD VILLAGE
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State | CO
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Zip | 80111-3305
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Country | US
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Telephone | 303-771-3102
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. TAMARA JOHNSON
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Credential | MD
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Telephone | 303-771-3102
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | CO49380
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License Number State | CO
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