Provider Demographics
NPI:1558547646
Name:HEALTHONE CLINIC SERVICES - OCCUPATIONAL MEDICINE LLC
Entity Type:Organization
Organization Name:HEALTHONE CLINIC SERVICES - OCCUPATIONAL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:A
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-584-8000
Mailing Address - Street 1:4900 S MONACO ST
Mailing Address - Street 2:#210
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3486
Mailing Address - Country:US
Mailing Address - Phone:303-584-8000
Mailing Address - Fax:303-584-8141
Practice Address - Street 1:4900 S MONACO ST
Practice Address - Street 2:#210
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80237-3486
Practice Address - Country:US
Practice Address - Phone:303-584-8000
Practice Address - Fax:303-584-8141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-18
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CODO3819Medicare PIN
COC811604Medicare PIN