Provider Demographics
NPI:1790004612
Name:MEDVACATION LLC
Entity Type:Organization
Organization Name:MEDVACATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TARAS
Authorized Official - Middle Name:
Authorized Official - Last Name:KUZIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-837-2378
Mailing Address - Street 1:PO BOX 653
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80201-0653
Mailing Address - Country:US
Mailing Address - Phone:720-837-2378
Mailing Address - Fax:
Practice Address - Street 1:2340 CURTIS STREET UNIT #3
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205
Practice Address - Country:US
Practice Address - Phone:720-837-2378
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-18
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA0006XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Fertility Facility
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility