Provider Demographics
NPI:1578583969
Name:TOTAL HEALTHCARE DBA CENTURA CENTERS FOR OCCUPATIONAL MEDICINE
Entity Type:Organization
Organization Name:TOTAL HEALTHCARE DBA CENTURA CENTERS FOR OCCUPATIONAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUE
Authorized Official - Middle Name:C
Authorized Official - Last Name:JARDON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:719-475-9496
Mailing Address - Street 1:3030 N CIRCLE DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1177
Mailing Address - Country:US
Mailing Address - Phone:719-475-9496
Mailing Address - Fax:719-471-4448
Practice Address - Street 1:3030 N CIRCLE DR
Practice Address - Street 2:SUITE 210
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1177
Practice Address - Country:US
Practice Address - Phone:719-475-9496
Practice Address - Fax:719-471-4448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO84092732261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center