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General NPI Number Information
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NPI Number | 1407390586
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Entity Type | Organization
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Legal Business Name | DEPARTMENT OF JUSTICE
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Dates
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Enumeration Date | 12/08/2016
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Last Update Date | 12/08/2016
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Provider Practice Location Address
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Address Line | 9595 W QUINCY AVE
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City | LITTLETON
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State | CO
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Zip | 80123-1159
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Country | US
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Telephone | 303-763-4300
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Fax | 303-980-2332
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Provider Business Mailing Address
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Address Line | 1275 CAPRICORN CT
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City | COLORADO SPRINGS
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State | CO
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Zip | 80905-7175
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Country | US
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Telephone | 719-475-7539
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | DR. GEORGE JAMES SANTINI
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Credential | MD
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Telephone | 303-763-4300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2400X
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Taxonomy Name | Prison Health Clinic/Center
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License Number | A88608
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License Number State | CA
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