=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780062315
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GENERAL HEALTH MEDICAL PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/15/2015
-----------------------------------------------------
Last Update Date | 11/20/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 700 COLORADO BLVD STE 420
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80206-4084
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-924-1478
-----------------------------------------------------
Fax | 877-520-8928
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 700 COLORADO BLVD STE 420
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80206-4084
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-924-1478
-----------------------------------------------------
Fax | 877-520-8928
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NURSE PRACTITIONER/MEDICAL DIRECTOR
-----------------------------------------------------
Name | ISA JO
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 209-241-4787
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | APN.0991226
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------