Provider Demographics
NPI:1457549461
Name:HEALTHONE CLINIC SERVICES - MEDICAL SPECIALTIES LLC
Entity Type:Organization
Organization Name:HEALTHONE CLINIC SERVICES - MEDICAL SPECIALTIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:REBOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-372-5004
Mailing Address - Street 1:2000 HEALTH PARK DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4525
Mailing Address - Country:US
Mailing Address - Phone:615-372-5426
Mailing Address - Fax:
Practice Address - Street 1:1601 E 19TH AVE STE 4350
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1253
Practice Address - Country:US
Practice Address - Phone:303-228-1240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO72707062Medicaid
NM14173565Medicaid
CO30906571Medicaid
CO94170363Medicaid
CO74305263Medicaid
CO72707062Medicaid
COC810776Medicare PIN