Provider Demographics
NPI:1134476179
Name:AGELESS MEN'S HEALTH HOLDINGS, INC
Entity Type:Organization
Organization Name:AGELESS MEN'S HEALTH HOLDINGS, INC
Other - Org Name:AGELESS MEN'S HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TEAH
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-205-3999
Mailing Address - Street 1:8575 E ARAPAHOE RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80112-1435
Mailing Address - Country:US
Mailing Address - Phone:303-770-0028
Mailing Address - Fax:303-770-0085
Practice Address - Street 1:8575 E ARAPAHOE RD
Practice Address - Street 2:SUITE G
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80112-1435
Practice Address - Country:US
Practice Address - Phone:303-770-0028
Practice Address - Fax:303-770-0085
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AGELESS MEN'S HEALTH HOLDINGS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-09
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty