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General NPI Number Information
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NPI Number | 1659290062
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Entity Type | Organization
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Legal Business Name | SMPA MEDICAL ONE, LLC
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Dates
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Enumeration Date | 07/11/2026
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Last Update Date | 07/11/2026
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Provider Practice Location Address
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Address Line | 10622 RACINE ST
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City | COMMERCE CITY
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State | CO
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Zip | 80022-6635
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Country | US
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Telephone | 303-503-3980
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Fax |
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Provider Business Mailing Address
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Address Line | 10622 RACINE ST
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City | COMMERCE CITY
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State | CO
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Zip | 80022-6635
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Country | US
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Telephone | 303-503-3980
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. SHANE EUGENE MASS
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Credential | DMSC, MPA, PA-C
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Telephone | 303-503-3980
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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 |
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License Number State |
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