MEDICARE: C9 CORP

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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1972270254
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	C9 CORP

Provider Business Mailing Address
First Line	:	125 INVERNESS DR E STE 320
Second Line	:
City	:	ENGLEWOOD
State	:	CO
Zip	:	80112-5139
Country	:	US
Telephone Number	:	720-468-3306
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 INVERNESS DR E STE 320
Second Line	:
City	:	ENGLEWOOD
State	:	CO
Zip	:	80112-5139
Country	:	US
Telephone Number	:	720-468-3306
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANDREW V FORCINA
Credential	:
Telephone Number	:	720-468-3306

Provider Enumeration Date	:	08/25/2021
Last Update Date	:	08/25/2021

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Directions to “C9 CORP ” Practice Location

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