MEDICARE: SOUTH DENVER NEPHROLOGY ASSOCIATES 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	207RN0300X	Nephrology Physician
2	207RN0300X	Nephrology Physician	23200	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	:	1710910823
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH DENVER NEPHROLOGY ASSOCIATES PLLC

Provider Business Mailing Address
First Line	:	950 E HARVARD AVE
Second Line	:	SUITE 240
City	:	DENVER
State	:	CO
Zip	:	80210-7006
Country	:	US
Telephone Number	:	303-871-0977
Fax Number	:	303-733-2387

Provider Business Practice Location Address
First Line	:	950 E HARVARD AVE
Second Line	:	SUITE 240
City	:	DENVER
State	:	CO
Zip	:	80210-7006
Country	:	US
Telephone Number	:	303-871-0977
Fax Number	:	303-733-2387

Authorized Official
Title or Position	:	PRESIDENT/PARTNER
Name	:	MARK A DILLINGHAM
Credential	:	M.D
Telephone Number	:	303-891-0977

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	12/11/2013

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