Provider Demographics
NPI:1932507613
Name:MEDNOW CLINICS, INC
Entity Type:Organization
Organization Name:MEDNOW CLINICS, INC
Other - Org Name:SOUTH LOGAN FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-733-3764
Mailing Address - Street 1:895 S LOGAN ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-4127
Mailing Address - Country:US
Mailing Address - Phone:303-733-3764
Mailing Address - Fax:303-733-0868
Practice Address - Street 1:895 S LOGAN ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-4127
Practice Address - Country:US
Practice Address - Phone:303-733-3764
Practice Address - Fax:303-733-0868
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDNOW CLINICS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-12-12
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO35543261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01355437Medicaid