MEDICARE: GREEN VALLEY RANCH URGENT CARE CENTER PROF. 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	261QU0200X	Urgent Care Clinic/Center	36486	CO

General Provider Information

NPI Number	:	1871787366
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREEN VALLEY RANCH URGENT CARE CENTER PROF. LLC

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	:	M.D./OWNER
Name	:	DR. AUGUSTINE U OBINNAH
Credential	:	M.D.
Telephone Number	:	303-344-3700

Provider Enumeration Date	:	08/28/2007
Last Update Date	:	01/29/2008

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