Provider Demographics
NPI:1942605761
Name:COLORADO PHYSICIANS HEALTH ASSOCIATES, LLC
Entity Type:Organization
Organization Name:COLORADO PHYSICIANS HEALTH ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:SWANSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:720-359-7980
Mailing Address - Street 1:5340 S QUEBEC ST
Mailing Address - Street 2:SUITE 210-D
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-1909
Mailing Address - Country:US
Mailing Address - Phone:720-359-7980
Mailing Address - Fax:719-260-5921
Practice Address - Street 1:5340 S QUEBEC ST
Practice Address - Street 2:SUITE 210-D
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-1909
Practice Address - Country:US
Practice Address - Phone:720-359-7980
Practice Address - Fax:719-260-5921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-23
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR0018703208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty