MEDICARE: SIMPLY VAX, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1013678135
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIMPLY VAX, PLLC

Provider Business Mailing Address
First Line	:	239 W 67TH CT
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80538-1177
Country	:	US
Telephone Number	:	970-599-0330
Fax Number	:

Provider Business Practice Location Address
First Line	:	239 W 67TH CT
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80538-1177
Country	:	US
Telephone Number	:	970-599-0330
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MELISSA RHOADS
Credential	:
Telephone Number	:	970-599-0330

Provider Enumeration Date	:	01/02/2022
Last Update Date	:	01/15/2022

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