Provider Demographics
NPI:1396090387
Name:COLORADO NEUROLOGY AND EPILEPSY CLINIC, PLLC
Entity type:Organization
Organization Name:COLORADO NEUROLOGY AND EPILEPSY CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:SEAWELL
Authorized Official - Last Name:CLEMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-470-9553
Mailing Address - Street 1:554 MOONMIST CT
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80126-5693
Mailing Address - Country:US
Mailing Address - Phone:303-470-9553
Mailing Address - Fax:720-583-6796
Practice Address - Street 1:206 W. COUNTY LINE RD
Practice Address - Street 2:STE 320
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129-2321
Practice Address - Country:US
Practice Address - Phone:303-470-9553
Practice Address - Fax:720-583-6796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO502552084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty