Provider Demographics
NPI: | 1245619451 |
---|---|
Name: | YOGIS CHOICE HEALTH CARE LLC |
Entity Type: | Organization |
Organization Name: | YOGIS CHOICE HEALTH CARE LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PHYSICIAN |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | JONATHAN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | BLOCH |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DO |
Authorized Official - Phone: | 303-520-4336 |
Mailing Address - Street 1: | 1633 FILLMORE ST STE GL3 |
Mailing Address - Street 2: | |
Mailing Address - City: | DENVER |
Mailing Address - State: | CO |
Mailing Address - Zip Code: | 80206-1545 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 303-520-4336 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1633 FILLMORE ST STE GL3 |
Practice Address - Street 2: | |
Practice Address - City: | DENVER |
Practice Address - State: | CO |
Practice Address - Zip Code: | 80206 |
Practice Address - Country: | US |
Practice Address - Phone: | 303-520-4336 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2015-05-20 |
Last Update Date: | 2022-07-21 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CO | 43597 | 101Y00000X, 101YA0400X, 101YM0800X, 132700000X, 202C00000X, 204D00000X, 207Q00000X, 208100000X, 2083P0500X, 2083S0010X, 2083X0100X, 208D00000X, 208VP0000X, 261QH0100X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 101Y00000X | Behavioral Health & Social Service Providers | Counselor | Group - Multi-Specialty | |
No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
No | 132700000X | Dietary & Nutritional Service Providers | Dietary Manager | Group - Multi-Specialty | |
No | 202C00000X | Allopathic & Osteopathic Physicians | Independent Medical Examiner | Group - Multi-Specialty | |
No | 204D00000X | Allopathic & Osteopathic Physicians | Neuromusculoskeletal Medicine & OMM | Group - Multi-Specialty | |
No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
No | 2083P0500X | Allopathic & Osteopathic Physicians | Preventive Medicine | Preventive Medicine/Occupational Environmental Medicine | Group - Multi-Specialty |
No | 2083S0010X | Allopathic & Osteopathic Physicians | Preventive Medicine | Sports Medicine | Group - Multi-Specialty |
No | 2083X0100X | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine | Group - Multi-Specialty |
No | 208D00000X | Allopathic & Osteopathic Physicians | General Practice | Group - Multi-Specialty | |
No | 208VP0000X | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | Group - Multi-Specialty |
No | 261QH0100X | Ambulatory Health Care Facilities | Clinic/Center | Health Service | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
CO | 40855 | Medicare UPIN | |
CO | B4545 | Medicare PIN |