Provider Demographics
NPI:1457402075
Name:GREEN VALLEY RANCH MEDICAL CLINIC & URGENT CARE
Entity Type:Organization
Organization Name:GREEN VALLEY RANCH MEDICAL CLINIC & URGENT CARE
Other - Org Name:AUGUSTINE U OBINNAH
Other - Org Type:Other Name
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AUGUSTINE
Authorized Official - Middle Name:UJUNWA
Authorized Official - Last Name:OBINNAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-344-8700
Mailing Address - Street 1:4809 ARGONNE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80249-6834
Mailing Address - Country:US
Mailing Address - Phone:303-344-8700
Mailing Address - Fax:303-344-0200
Practice Address - Street 1:4809 ARGONNE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80249-6834
Practice Address - Country:US
Practice Address - Phone:303-344-8700
Practice Address - Fax:303-344-0200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA665239OtherBLUE CROSS
CO18970222Medicaid
COC511898Medicare PIN