Provider Demographics
NPI:1518542976
Name:MPP INFUSION CENTER OF DURANGO, LLC
Entity Type:Organization
Organization Name:MPP INFUSION CENTER OF DURANGO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-384-4100
Mailing Address - Street 1:1726 COLE BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80401-3262
Mailing Address - Country:US
Mailing Address - Phone:720-465-5030
Mailing Address - Fax:720-465-5040
Practice Address - Street 1:270 E 8TH AVE STE N-101
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5708
Practice Address - Country:US
Practice Address - Phone:561-323-8987
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty