Provider Demographics
NPI:1568070944
Name:SCL HEALTH MEDICAL GROUP - DENVER, LLC
Entity Type:Organization
Organization Name:SCL HEALTH MEDICAL GROUP - DENVER, LLC
Other - Org Name:FIRESTONE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-272-0231
Mailing Address - Street 1:500 ELDORADO BLVD STE 6300
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021-3422
Mailing Address - Country:US
Mailing Address - Phone:303-272-0566
Mailing Address - Fax:
Practice Address - Street 1:8350 COLORADO BLVD UNIT 160
Practice Address - Street 2:
Practice Address - City:FIRESTONE
Practice Address - State:CO
Practice Address - Zip Code:80504-6803
Practice Address - Country:US
Practice Address - Phone:303-689-5160
Practice Address - Fax:303-689-5175
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SCL HEALTH FRONT RANGE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-07-21
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty