Provider Demographics
NPI:1801288352
Name:CEREHEALTH MSO, LLC
Entity type:Organization
Organization Name:CEREHEALTH MSO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:AMMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-838-2785
Mailing Address - Street 1:991 SOUTHPARK DR
Mailing Address - Street 2:200
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-5688
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:991 SOUTHPARK DR
Practice Address - Street 2:200
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-5688
Practice Address - Country:US
Practice Address - Phone:720-242-9081
Practice Address - Fax:866-433-3965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-20
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO461732085D0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085D0003XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic NeuroimagingGroup - Single Specialty