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General NPI Number Information
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NPI Number | 1467846477
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Entity Type | Organization
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Legal Business Name | COREVISION NETWORK, LLC
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Dates
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Enumeration Date | 03/27/2015
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Last Update Date | 06/14/2016
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Provider Practice Location Address
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Address Line | 14201 E 4TH AVE BUILDING 4, SUITE 110
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City | AURORA
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State | CO
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Zip | 80011-8748
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Country | US
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Telephone | 404-809-7764
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Fax |
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Provider Business Mailing Address
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Address Line | 411 S CASCADE AVE SUITE 100
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City | COLORADO SPRINGS
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State | CO
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Zip | 80903-3809
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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 | OWNER
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Name | MR. NATHANIEL HARDAGE JR.
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Credential |
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Telephone | 404-809-7764
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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