MEDICARE: GREEN VALLEY RANCH MEDICAL CLINIC & URGENT CARE

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	261QP2300X	Primary Care Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	GA665239	OTHER		BLUE CROSS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457402075
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREEN VALLEY RANCH MEDICAL CLINIC & URGENT CARE

Provider Business Mailing Address
First Line	:	4809 ARGONNE ST
Second Line	:	SUITE 100
City	:	DENVER
State	:	CO
Zip	:	80249-6834
Country	:	US
Telephone Number	:	303-344-8700
Fax Number	:	303-344-0200

Provider Business Practice Location Address
First Line	:	4809 ARGONNE ST
Second Line	:	SUITE 100
City	:	DENVER
State	:	CO
Zip	:	80249-6834
Country	:	US
Telephone Number	:	303-344-8700
Fax Number	:	303-344-0200

Authorized Official
Title or Position	:	MEMBER/OWNER
Name	:	DR. AUGUSTINE UJUNWA OBINNAH
Credential	:	M.D.
Telephone Number	:	303-344-8700

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	11/09/2016

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Directions to “GREEN VALLEY RANCH MEDICAL CLINIC & URGENT CARE ” Practice Location

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