MEDICARE: CENTURA VENTURES, LLC

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	261QP2000X	Physical Therapy Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1073882197	OTHER		OLD NPI
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629600754
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTURA VENTURES, LLC

Provider Business Mailing Address
First Line	:	PO BOX 801172
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64180-1172
Country	:	US
Telephone Number	:	800-953-0104
Fax Number	:	303-765-6670

Provider Business Practice Location Address
First Line	:	1263 LAKE PLAZA DR STE 210B
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-3564
Country	:	US
Telephone Number	:	719-776-3350
Fax Number	:	719-776-3374

Authorized Official
Title or Position	:	VP, AMBULATORY SERVICES
Name	:	MS. DEBRA CARPENTER
Credential	:	RN
Telephone Number	:	303-765-6998

Provider Enumeration Date	:	02/06/2020
Last Update Date	:	12/21/2020

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Directions to “CENTURA VENTURES, LLC ” Practice Location

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