Provider Demographics
NPI:1134669930
Name:MEDNET COLORADO MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:MEDNET COLORADO MEDICAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DON
Authorized Official - Middle Name:
Authorized Official - Last Name:BURRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-887-4138
Mailing Address - Street 1:14255 COUNTY ROAD 87
Mailing Address - Street 2:
Mailing Address - City:FLEMING
Mailing Address - State:CO
Mailing Address - Zip Code:80728-9602
Mailing Address - Country:US
Mailing Address - Phone:303-887-4138
Mailing Address - Fax:
Practice Address - Street 1:14255 COUNTY ROAD 87
Practice Address - Street 2:
Practice Address - City:FLEMING
Practice Address - State:CO
Practice Address - Zip Code:80728-9602
Practice Address - Country:US
Practice Address - Phone:303-887-4138
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-28
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No293D00000XLaboratoriesPhysiological LaboratoryGroup - Multi-Specialty