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General NPI Number Information
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NPI Number | 1467819144
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Entity Type | Organization
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Legal Business Name | CARESPAN USA, INC.
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Dates
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Enumeration Date | 01/26/2016
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Last Update Date | 01/26/2016
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Provider Practice Location Address
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Address Line | 7102 LA VISTA PL SUITE 203
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City | LONGMONT
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State | CO
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Zip | 80503-0800
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Country | US
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Telephone | 303-800-8296
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Fax | 303-800-8226
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Provider Business Mailing Address
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Address Line | 7102 LA VISTA PL SUITE 203
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City | LONGMONT
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State | CO
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Zip | 80503-0800
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Country | US
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Telephone | 303-800-8296
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Fax | 303-800-8226
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Authorized Official
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Title or Position | CHIEF MEDICAL OFFICER
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Name | DR. TERRY R. KNAPP
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Credential | M.D.
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Telephone | 303-800-8296
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 20151449233
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License Number State | CO
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