Provider Demographics
NPI:1619019098
Name:HCAHEALTHONE LLC
Entity Type:Organization
Organization Name:HCAHEALTHONE LLC
Other - Org Name:CENTENNIAL MEDICAL PLAZA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:COFFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACY
Authorized Official - Phone:303-699-3070
Mailing Address - Street 1:14200 E ARAPAHOE RD
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-4065
Mailing Address - Country:US
Mailing Address - Phone:303-699-3070
Mailing Address - Fax:303-699-3091
Practice Address - Street 1:14200 E ARAPAHOE RD
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-4065
Practice Address - Country:US
Practice Address - Phone:303-699-3070
Practice Address - Fax:303-699-3091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3700000053336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO03001799Medicaid
CO0611625OtherNABP NUMBER