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General NPI Number Information
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NPI Number | 1669871265
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Entity Type | Organization
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Legal Business Name | BARIATRIC AND METABOLIC CENTER OF COLORADO
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Dates
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Enumeration Date | 08/19/2014
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Last Update Date | 08/19/2014
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Provider Practice Location Address
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Address Line | 9397 CROWN CREST BLVD STE 440
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City | PARKER
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State | CO
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Zip | 80138-8789
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Country | US
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Telephone | 303-269-4370
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Fax | 303-269-4371
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Provider Business Mailing Address
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Address Line | 9397 CROWN CREST BLVD STE 440
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City | PARKER
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State | CO
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Zip | 80138-8789
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Country | US
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Telephone | 303-269-4370
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | DESTRIA BENNIS
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Credential |
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Telephone | 303-357-4040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA.0004017
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License Number State | CO
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