Provider Demographics
NPI:1740580562
Name:ROMANAT CLINIC, INC
Entity Type:Organization
Organization Name:ROMANAT CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:HAFTU
Authorized Official - Middle Name:
Authorized Official - Last Name:GEBREHIWOT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-364-1422
Mailing Address - Street 1:13901 E. EXPOSITION AVE
Mailing Address - Street 2:#230
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-2535
Mailing Address - Country:US
Mailing Address - Phone:303-364-1422
Mailing Address - Fax:303-364-1454
Practice Address - Street 1:13901 E. EXPOSITION AVE
Practice Address - Street 2:#230
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-2535
Practice Address - Country:US
Practice Address - Phone:303-364-1422
Practice Address - Fax:303-364-1454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-26
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO46877261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO74970551Medicaid
TXCOB4430Medicare PIN