Provider Demographics
NPI:1760094585
Name:SCL HEALTH MEDICAL GROUP - DENVER, LLC
Entity Type:Organization
Organization Name:SCL HEALTH MEDICAL GROUP - DENVER, LLC
Other - Org Name:WHEAT RIDGE CLINIC - DIABETES & ENDOCRINOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FIANANCE
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-272-0231
Mailing Address - Street 1:500 ELDORADO BLVD STE 6300
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021-3422
Mailing Address - Country:US
Mailing Address - Phone:303-272-0566
Mailing Address - Fax:
Practice Address - Street 1:3555 LUTHERAN PKWY STE 180
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-6000
Practice Address - Country:US
Practice Address - Phone:303-403-7933
Practice Address - Fax:303-403-7945
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SCL HEALTH FRONT RANGE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-08-21
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty