Provider Demographics
NPI:1629843362
Name:HEARTLIGHT FAMILY CLINIC, LLC
Entity Type:Organization
Organization Name:HEARTLIGHT FAMILY CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:HERRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-249-0908
Mailing Address - Street 1:1421 S POTOMAC ST STE 140
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-4535
Mailing Address - Country:US
Mailing Address - Phone:204-853-1787
Mailing Address - Fax:
Practice Address - Street 1:1421 S POTOMAC ST STE 140
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-4535
Practice Address - Country:US
Practice Address - Phone:204-853-1787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEARTLIGHT FAMILY CLINIC, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-11-22
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty