Provider Demographics
NPI:1639376585
Name:HEALTHONE CLINIC SERVICES-SURGICAL SPECIALTIES LLC
Entity Type:Organization
Organization Name:HEALTHONE CLINIC SERVICES-SURGICAL SPECIALTIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-584-8119
Mailing Address - Street 1:2000 HEALTH PARK DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4525
Mailing Address - Country:US
Mailing Address - Phone:615-372-5426
Mailing Address - Fax:866-831-4898
Practice Address - Street 1:1601 E 19TH AVE STE 5100
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1254
Practice Address - Country:US
Practice Address - Phone:303-301-9014
Practice Address - Fax:303-832-0988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO51131030Medicaid
CO61923249Medicaid
CO97427055Medicaid
CO94775753Medicaid
CO12652776Medicaid
CO16558855Medicaid
CO75732238Medicaid
CO81654251Medicaid
CO61923249Medicaid
CO75732238Medicaid