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General NPI Number Information
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NPI Number | 1952819450
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Entity Type | Organization
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Legal Business Name | COLORADO SENIOR PROVIDER NETWORK
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Dates
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Enumeration Date | 01/18/2018
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Last Update Date | 03/10/2020
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Provider Practice Location Address
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Address Line | 2221 E ARAPAHOE RD UNIT 3728
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City | CENTENNIAL
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State | CO
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Zip | 80161-5079
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Country | US
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Telephone | 303-877-7239
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3728
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City | LITTLETON
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State | CO
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Zip | 80161-3728
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Country | US
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Telephone | 303-877-7239
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Fax |
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Authorized Official
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Title or Position | GENERAL PARTNER
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Name | MARK TALMAGE
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Credential | MD
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Telephone | 303-877-7239
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | DR0027631
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License Number State | CO
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