Provider Demographics
NPI: | 1093463069 |
---|---|
Name: | CARBON HEALTH MEDICAL GROUP OF FLORIDA PA |
Entity Type: | Organization |
Organization Name: | CARBON HEALTH MEDICAL GROUP OF FLORIDA PA |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CREDENTIALING MANAGER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | GIANNA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | PAPA |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 415-446-1733 |
Mailing Address - Street 1: | 2100 FRANKLIN ST STE 355 |
Mailing Address - Street 2: | |
Mailing Address - City: | OAKLAND |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 94612-3140 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 415-446-1733 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2860 E HARMONY RD STE OL |
Practice Address - Street 2: | |
Practice Address - City: | FORT COLLINS |
Practice Address - State: | CO |
Practice Address - Zip Code: | 80528-8700 |
Practice Address - Country: | US |
Practice Address - Phone: | 970-235-8153 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | CARBON HEALTH MEDICAL GROUP OF FLORIDA PA |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2022-03-17 |
Last Update Date: | 2023-11-17 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QU0200X | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |