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General NPI Number Information
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NPI Number | 1861691719
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Entity Type | Organization
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Legal Business Name | WESTERN MEDICAL CENTER PC
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Dates
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Enumeration Date | 07/12/2007
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Last Update Date | 07/12/2007
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Provider Practice Location Address
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Address Line | 1805 KIPLING ST
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City | LAKEWOOD
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State | CO
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Zip | 80215
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Country | US
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Telephone | 303-232-3232
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Fax | 303-232-3232
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Provider Business Mailing Address
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Address Line | 1805 KIPLING ST
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City | LAKEWOOD
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State | CO
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Zip | 80215
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Country | US
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Telephone | 303-232-3232
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Fax | 303-232-8922
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Authorized Official
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Title or Position | MEDICAL DIRECTOR STAFF PHYSICIAN
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Name | HENRY MANNING PICKETT
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Credential | MD
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Telephone | 303-232-3232
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 18721
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License Number State | CO
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