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General NPI Number Information
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NPI Number | 1780039669
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Entity Type | Organization
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Legal Business Name | TRUCARE MTM LLC
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Dates
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Enumeration Date | 04/28/2016
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Last Update Date | 04/28/2016
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Provider Practice Location Address
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Address Line | 2283 S MONACO PKWY STE 101
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City | DENVER
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State | CO
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Zip | 80222-5845
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Country | US
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Telephone | 720-295-4229
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Fax |
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Provider Business Mailing Address
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Address Line | 4860 CHAMBERS RD # 206
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City | DENVER
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State | CO
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Zip | 80239-5152
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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 | KEN RODERICK
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Credential |
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Telephone | 720-295-4229
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 0002005990
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License Number State | CO
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