Provider Demographics
NPI:1790370914
Name:SQUARE ONE HEALTH LLC
Entity Type:Organization
Organization Name:SQUARE ONE HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:GUBBELS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:970-207-4463
Mailing Address - Street 1:4914 BROOKFIELD DR UNIT A
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-3199
Mailing Address - Country:US
Mailing Address - Phone:970-207-4463
Mailing Address - Fax:
Practice Address - Street 1:257 BOARDWALK DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3661
Practice Address - Country:US
Practice Address - Phone:970-207-4463
Practice Address - Fax:970-207-4052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty