=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841956307
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PURE HEALTHCARE OF COLORADO LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/09/2021
-----------------------------------------------------
Last Update Date | 04/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 950 E HARVARD AVE STE 480
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80210-7004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-702-0444
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4179 S RIVERBOAT RD STE 220
-----------------------------------------------------
City | TAYLORSVILLE
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84123-2986
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROJECT MANAGER
-----------------------------------------------------
Name | NATALIE BECKER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 406-384-6502
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM1300X
-----------------------------------------------------
Taxonomy Name | Multi-Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------