Provider Demographics
NPI:1962024653
Name:SOUTH DENVER REGEN INC
Entity Type:Organization
Organization Name:SOUTH DENVER REGEN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHONNESSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-738-0390
Mailing Address - Street 1:8765 E ORCHARD RD STE 702
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-5009
Mailing Address - Country:US
Mailing Address - Phone:303-738-0390
Mailing Address - Fax:866-238-2721
Practice Address - Street 1:8765 E ORCHARD RD STE 702
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-5009
Practice Address - Country:US
Practice Address - Phone:303-738-0390
Practice Address - Fax:866-238-2721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-15
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center