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General NPI Number Information
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NPI Number | 1306501341
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Entity Type | Organization
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Legal Business Name | BLOOM COLORADO LLC
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Dates
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Enumeration Date | 11/04/2021
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Last Update Date | 11/04/2021
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Provider Practice Location Address
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Address Line | 1942 E MAIN ST
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City | CORTEZ
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State | CO
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Zip | 81321-3039
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Country | US
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Telephone | 970-609-2001
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5943
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City | VIRGINIA BEACH
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State | VA
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Zip | 23471-0943
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SPENCER SMITH
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Credential |
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Telephone | 970-609-2001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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