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NPI Code Detail

MEDICARE: CENTURA VENTURES, LLC

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
12081P0004XSpinal Cord Injury Medicine Physician

General Provider Information

NPI Number : 1861821563
Entity Type Code : Organization
Provider Name (Legal Business Name) : CENTURA VENTURES, LLC
Provider Business Mailing Address
First Line : 1391 SPEER BLVD
Second Line : SUITE 600
City : DENVER
State : CO
Zip : 80204-2508
Country : US
Telephone Number : 303-561-5000
Fax Number : 303-561-5050
Provider Business Practice Location Address
First Line : 3030 N CIRCLE DR
Second Line : SUITE 212
City : COLORADO SPRINGS
State : CO
Zip : 80909-1177
Country : US
Telephone Number : 719-776-4852
Fax Number :
Authorized Official
Title or Position : ADMINISTRATOR
Name : SUE JARDON
Credential :
Telephone Number : 719-571-8899
Provider Enumeration Date : 11/04/2013
Last Update Date : 08/25/2015

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Directions to “CENTURA VENTURES, LLC ” Practice Location

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