Provider Demographics
NPI:1568008241
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:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:SMITHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-584-8119
Mailing Address - Street 1:525 HATHAWAY ST
Mailing Address - Street 2:
Mailing Address - City:FAIRPLAY
Mailing Address - State:CO
Mailing Address - Zip Code:80440
Mailing Address - Country:US
Mailing Address - Phone:719-836-0334
Mailing Address - Fax:719-836-0336
Practice Address - Street 1:525 HATHAWAY ST
Practice Address - Street 2:
Practice Address - City:FAIRPLAY
Practice Address - State:CO
Practice Address - Zip Code:80440
Practice Address - Country:US
Practice Address - Phone:719-836-0334
Practice Address - Fax:719-836-0336
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTHONE CLINIC SERVICES - PRIMARY CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-11-18
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site