HEALTHONE CLINIC SERVICES - PEDIATRIC SPECIALTIES LLC

Provider Demographics

• NPI: 1720293251
• Name: HEALTHONE CLINIC SERVICES - PEDIATRIC SPECIALTIES LLC
• Entity Type: Organization
• Organization Name: HEALTHONE CLINIC SERVICES - PEDIATRIC SPECIALTIES LLC
• Authorized Official - Title/Position: VP
• Authorized Official - First Name: JOHN
• Authorized Official - Last Name: REBOK
• Authorized Official - Phone: 615-372-5004
• Mailing Address - Street 1: 2000 HEALTH PARK DR
• 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: 866-831-4898
• Practice Address - Street 1: 2001 N HIGH ST
• Practice Address - City: DENVER
• Practice Address - State: CO
• Practice Address - Zip Code: 80205-5555
• Practice Address - Country: US
• Practice Address - Phone: 720-754-1000
• Practice Address - Fax: 303-861-6254
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2007-05-10
• Last Update Date: 2023-01-02

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	208000000X	Allopathic & Osteopathic Physicians	Pediatrics		Group - Multi-Specialty
No	207X00000X	Allopathic & Osteopathic Physicians	Orthopaedic Surgery		Group - Multi-Specialty
No	207Y00000X	Allopathic & Osteopathic Physicians	Otolaryngology		Group - Multi-Specialty
No	2080P0202X	Allopathic & Osteopathic Physicians	Pediatrics	Pediatric Cardiology	Group - Multi-Specialty
No	2080P0207X	Allopathic & Osteopathic Physicians	Pediatrics	Pediatric Hematology-Oncology	Group - Multi-Specialty
No	2080P0208X	Allopathic & Osteopathic Physicians	Pediatrics	Pediatric Infectious Diseases	Group - Multi-Specialty
No	2080P0210X	Allopathic & Osteopathic Physicians	Pediatrics	Pediatric Nephrology	Group - Multi-Specialty
No	2084S0012X	Allopathic & Osteopathic Physicians	Psychiatry & Neurology	Sleep Medicine	Group - Multi-Specialty
No	2086S0120X	Allopathic & Osteopathic Physicians	Surgery	Pediatric Surgery	Group - Multi-Specialty
No	231H00000X	Speech, Language and Hearing Service Providers	Audiologist		Group - Multi-Specialty
No	261Q00000X	Ambulatory Health Care Facilities	Clinic/Center		Group - Multi-Specialty
No	363A00000X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant		Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
CO	39831264	Medicaid
CO	88150062	Medicaid
CO	06653065	Medicaid
CO	91103355	Medicaid
CO	01026208	Medicaid
CO	17088372	Medicaid
CO	04558367	Medicaid
CO	35958898	Medicaid
CO	73801089	Medicaid
CO	37402552	Medicaid
NM	65724089	Medicaid
CO	78725259	Medicaid
CO	91103355	Medicaid