MEDICARE: DISPATCHHEALTH ADVANCED CARE - WASHINGTON PC

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	208M00000X	Hospitalist Physician

General Provider Information

NPI Number	:	1093324659
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DISPATCHHEALTH ADVANCED CARE - WASHINGTON PC

Provider Business Mailing Address
First Line	:	3455 RINGSBY CT STE 102
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80216-4923
Country	:	US
Telephone Number	:	303-500-1518
Fax Number	:

Provider Business Practice Location Address
First Line	:	3455 RINGSBY CT STE 102
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80216-4923
Country	:	US
Telephone Number	:	303-500-1518
Fax Number	:

Authorized Official
Title or Position	:	CMO
Name	:	ANDREW WAGNER
Credential	:	MD
Telephone Number	:	303-500-1518

Provider Enumeration Date	:	07/29/2020
Last Update Date	:	07/29/2020

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