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General NPI Number Information
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NPI Number | 1528882453
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Entity Type | Organization
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Legal Business Name | BLUE ICEBERG LLC
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Dates
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Enumeration Date | 11/07/2024
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Last Update Date | 11/07/2024
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Provider Practice Location Address
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Address Line | 8601 W CROSS DR UNIT B1
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City | LITTLETON
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State | CO
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Zip | 80123-2200
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Country | US
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Telephone | 651-214-0197
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Fax |
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Provider Business Mailing Address
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Address Line | 8156 S WADSWORTH BLVD UNIT E-459
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City | LITTLETON
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State | CO
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Zip | 80128-9114
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Country | US
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Telephone | 651-214-0197
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. STEVE YANG
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Credential |
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Telephone | 651-214-0197
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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