Provider Demographics
NPI:1336669076
Name:LIVENEW, CO.
Entity Type:Organization
Organization Name:LIVENEW, CO.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-269-4370
Mailing Address - Street 1:9695 S YOSEMITE ST STE 285
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-2890
Mailing Address - Country:US
Mailing Address - Phone:303-269-4370
Mailing Address - Fax:303-269-4371
Practice Address - Street 1:9800 MT PYRAMID CT STE 300
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-2667
Practice Address - Country:US
Practice Address - Phone:303-269-4370
Practice Address - Fax:303-269-4371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-23
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RE0101X, 208600000X
CODR.0051485208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CODR.0051485OtherSTATE LICENSE