Provider Demographics
NPI:1942282249
Name:HEALTHONE CLINIC SERVICES, LLC
Entity Type:Organization
Organization Name:HEALTHONE CLINIC SERVICES, LLC
Other - Org Name:HEALTHONE MOUNTAIN VIEW NURSE MIDWIVES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:BIRMINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-373-7625
Mailing Address - Street 1:9141 GRANT ST
Mailing Address - Street 2:#B-45
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229-4374
Mailing Address - Country:US
Mailing Address - Phone:303-450-6667
Mailing Address - Fax:303-457-6742
Practice Address - Street 1:9141 GRANT ST
Practice Address - Street 2:#B-45
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-4374
Practice Address - Country:US
Practice Address - Phone:303-450-6667
Practice Address - Fax:303-457-6742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COGR37987551Medicaid