Provider Demographics
NPI:1740488535
Name:PROVIDENCE HEALTHCARE ASSOCIATES PC
Entity type:Organization
Organization Name:PROVIDENCE HEALTHCARE ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:COREY
Authorized Official - Last Name:MCCARTY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:720-985-6484
Mailing Address - Street 1:2761 W 120TH AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80234-2880
Mailing Address - Country:US
Mailing Address - Phone:303-357-5620
Mailing Address - Fax:
Practice Address - Street 1:2761 W 120TH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80234-2880
Practice Address - Country:US
Practice Address - Phone:303-357-5620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty