MEDICARE: ADVANCED HEALTH CARE ONE CENTER

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	302F00000X	Exclusive Provider Organization	37847	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538323548
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED HEALTH CARE ONE CENTER

Provider Business Mailing Address
First Line	:	2789 W ALAMEDA AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80219-3080
Country	:	US
Telephone Number	:	303-237-6162
Fax Number	:	303-237-6165

Provider Business Practice Location Address
First Line	:	2789 W ALAMEDA AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80219-3080
Country	:	US
Telephone Number	:	303-237-6162
Fax Number	:	303-237-6165

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. JOHN VAN WU
Credential	:	M.D.
Telephone Number	:	303-237-6162

Provider Enumeration Date	:	07/18/2008
Last Update Date	:	07/18/2008

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Directions to “ADVANCED HEALTH CARE ONE CENTER ” Practice Location

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