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General NPI Number Information
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NPI Number | 1366904443
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Entity Type | Organization
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Legal Business Name | VACCINE HIPPO CO LLC
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Dates
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Enumeration Date | 04/05/2019
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Last Update Date | 04/05/2019
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Provider Practice Location Address
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Address Line | 200 UNION BLVD STE 311
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City | LAKEWOOD
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State | CO
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Zip | 80228-1831
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Country | US
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Telephone | 866-829-2968
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Fax |
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Provider Business Mailing Address
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Address Line | 10040 W CHEYENNE AVE STE 170-146
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City | LAS VEGAS
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State | NV
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Zip | 89129-7719
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Country | US
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Telephone | 702-641-1776
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHAD COLUMBUS
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Credential |
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Telephone | 866-829-2968
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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