Provider Demographics
NPI:1114559572
Name:HEALOGICS SPECIALTY PHYSICIANS OF COLORADO-PROFESSIONAL, LLC
Entity Type:Organization
Organization Name:HEALOGICS SPECIALTY PHYSICIANS OF COLORADO-PROFESSIONAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-446-3519
Mailing Address - Street 1:PO BOX 645743
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45264-6018
Mailing Address - Country:US
Mailing Address - Phone:855-689-5105
Mailing Address - Fax:904-446-3032
Practice Address - Street 1:11600 W 2ND PL
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1527
Practice Address - Country:US
Practice Address - Phone:719-562-6110
Practice Address - Fax:719-562-6111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-04
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO49720252Medicaid
CO35233559Medicaid