=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457402075
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GREEN VALLEY RANCH MEDICAL CLINIC & URGENT CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/12/2007
-----------------------------------------------------
Last Update Date | 11/09/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4809 ARGONNE ST SUITE 100
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80249-6834
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-344-8700
-----------------------------------------------------
Fax | 303-344-0200
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4809 ARGONNE ST SUITE 100
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80249-6834
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-344-8700
-----------------------------------------------------
Fax | 303-344-0200
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER/OWNER
-----------------------------------------------------
Name | DR. AUGUSTINE UJUNWA OBINNAH
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 303-344-8700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------