Provider Demographics
NPI:1851796627
Name:COLORADO NEUROLOGY CENTER PLLC
Entity Type:Organization
Organization Name:COLORADO NEUROLOGY CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SIMON
Authorized Official - Middle Name:C
Authorized Official - Last Name:OH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-481-0030
Mailing Address - Street 1:1400 S. POTOMAC ST
Mailing Address - Street 2:#220
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-4522
Mailing Address - Country:US
Mailing Address - Phone:720-248-5200
Mailing Address - Fax:720-248-5201
Practice Address - Street 1:1400 S. POTOMAC ST
Practice Address - Street 2:#220
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-4522
Practice Address - Country:US
Practice Address - Phone:720-248-5200
Practice Address - Fax:720-248-5201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-23
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO492922084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty