Provider Demographics
NPI:1518141761
Name:HEALTHONE CLINIC SERVICES - PRIMARY CARE LLC
Entity Type:Organization
Organization Name:HEALTHONE CLINIC SERVICES - PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:REBOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-372-5004
Mailing Address - Street 1:2000 HEALTH PARK DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4525
Mailing Address - Country:US
Mailing Address - Phone:615-372-5426
Mailing Address - Fax:866-831-4898
Practice Address - Street 1:4545 E 9TH AVE STE 400
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-3904
Practice Address - Country:US
Practice Address - Phone:303-320-2929
Practice Address - Fax:303-388-1865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-24
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO34758551Medicaid
CO73570281Medicaid
CO31930743Medicaid
CO07709773Medicaid
CO13401548Medicaid
CO65724577Medicaid
CO30136253Medicaid
CO46684069Medicaid
CO31433367Medicaid
CO39771571Medicaid
CO27302270Medicaid
CO60827211Medicaid
CO98059378Medicaid
CO27302270Medicaid
CO73570281Medicaid