Provider Demographics
NPI:1275943201
Name:MSK MEDICAL LLC
Entity Type:Organization
Organization Name:MSK MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:W
Authorized Official - Middle Name:RAFER
Authorized Official - Last Name:LEACH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-870-8870
Mailing Address - Street 1:1 BROADWAY
Mailing Address - Street 2:A-100
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-3959
Mailing Address - Country:US
Mailing Address - Phone:303-455-6345
Mailing Address - Fax:303-455-6343
Practice Address - Street 1:1 BROADWAY
Practice Address - Street 2:A-100
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-3959
Practice Address - Country:US
Practice Address - Phone:303-455-6345
Practice Address - Fax:303-455-6343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-29
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO38790261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty