=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891221750
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ABC HEART HEALTH LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2017
-----------------------------------------------------
Last Update Date | 06/03/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 401 W HAMPDEN PL STE 260
-----------------------------------------------------
City | ENGLEWOOD
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80110-2471
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-789-1400
-----------------------------------------------------
Fax | 303-789-1401
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 401 W HAMPDEN PL STE 260
-----------------------------------------------------
City | ENGLEWOOD
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80110-2471
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-789-1400
-----------------------------------------------------
Fax | 303-789-1401
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATION
-----------------------------------------------------
Name | MICHELLE KLEIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 720-413-7222
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 31220
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QM1300X
-----------------------------------------------------
Taxonomy Name | Multi-Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------