MEDICARE: 2ND HOME MEDICAL CENTER 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	:	1104790294
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	2ND HOME MEDICAL CENTER PLLC

Provider Business Mailing Address
First Line	:	3131 S VAUGHN WAY STE 600
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80014-3508
Country	:	US
Telephone Number	:	303-999-7763
Fax Number	:	720-367-5443

Provider Business Practice Location Address
First Line	:	6880 E EVANS AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80224-2330
Country	:	US
Telephone Number	:	303-999-7763
Fax Number	:	720-367-5443

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	SAMI MITRI
Credential	:	DO
Telephone Number	:	303-999-7763

Provider Enumeration Date	:	10/01/2025
Last Update Date	:	10/06/2025

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