MEDICARE: CHANGING TIMES MEDICAL TECHNOLOGY

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	246RP1900X	Phlebotomy Technician
2	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1164003257
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHANGING TIMES MEDICAL TECHNOLOGY

Provider Business Mailing Address
First Line	:	1230 S PARKER RD STE 208
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80231-2119
Country	:	US
Telephone Number	:	303-593-1595
Fax Number	:	303-955-5963

Provider Business Practice Location Address
First Line	:	1230 S PARKER RD STE 208
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80231-2119
Country	:	US
Telephone Number	:	720-404-0424
Fax Number	:	303-955-5963

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	GWENDOLYNE THORNTON
Credential	:
Telephone Number	:	303-593-1595

Provider Enumeration Date	:	04/20/2021
Last Update Date	:	03/01/2022

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Directions to “CHANGING TIMES MEDICAL TECHNOLOGY ” Practice Location

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