Provider Demographics
NPI:1942648480
Name:NEURO CLINIC OF COLORADO LLC
Entity Type:Organization
Organization Name:NEURO CLINIC OF COLORADO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER / PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:WILY
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-481-0030
Mailing Address - Street 1:1400 S POTOMAC ST STE 220
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-4514
Mailing Address - Country:US
Mailing Address - Phone:303-481-0030
Mailing Address - Fax:
Practice Address - Street 1:1400 S POTOMAC ST STE 220
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-4514
Practice Address - Country:US
Practice Address - Phone:303-481-0030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-06
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty