Basic Information
| Provider Information | |||||||||
| NPI: | 1023062098 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HCA HEALTHONE LLC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | ROSE MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 4567 E 9TH AVE | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802203908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033202394 | ||||||||
| FaxNumber: | 3033202200 | ||||||||
| Practice Location | |||||||||
| Address1: | 4567 E 9TH AVE | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802203908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033202394 | ||||||||
| FaxNumber: | 3033202200 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2006 | ||||||||
| LastUpdateDate: | 05/27/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | COOK | ||||||||
| AuthorizedOfficialFirstName: | LYNN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 8042673996 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 05/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 01200385 | 05 | KY | MEDICAID | 0518039 | 01 | AETNA HMO PPO | OTHER | 100103460C | 05 | KS | MEDICAID | 38977320 | 01 | DENVER HEALTH MCO | OTHER | HS535OP | 05 | AK | MEDICAID | 00369278X | 05 | GA | MEDICAID | 100704510G | 05 | OK | MEDICAID | 304726676 | 05 | MI | MEDICAID | 378073603 | 01 | FEDERAL WORKERS COMP | OTHER | 919548300 | 05 | MN | MEDICAID | 200388020A | 05 | IN | MEDICAID | 408824 | 05 | AZ | MEDICAID | B5918 | 05 | NM | MEDICAID | COL0032N | 05 | AL | MEDICAID | XHSP33276 | 05 | CA | MEDICAID | 00058CO | 01 | BLUE CROSS | OTHER | 262460 | 05 | OR | MEDICAID | 738500500 | 05 | MD | MEDICAID | 7725302 | 05 | NJ | MEDICAID | 805198100 | 05 | ID | MEDICAID | 9810405000 | 05 | WV | MEDICAID | 11986 | 05 | TN | MEDICAID | 3021193 | 05 | WA | MEDICAID | 00983019 | 05 | NY | MEDICAID | 01470 | 05 | ND | MEDICAID | 05032008 | 05 | CO | MEDICAID | 060032 | 01 | KAISER SENIOR ADVANTAGE | OTHER | 090120200 | 05 | FL | MEDICAID | 1766208 | 05 | LA | MEDICAID | 000600326 | 05 | VA | MEDICAID | 0120622 | 05 | SD | MEDICAID | 016654501 | 05 | MO | MEDICAID | 071704301 | 05 | TX | MEDICAID | 139151105 | 05 | AR | MEDICAID | 2271438 | 05 | OH | MEDICAID | 80535700 | 05 | WI | MEDICAID | 001188301 | 05 | NV | MEDICAID | 113107900 | 05 | WY | MEDICAID | 410652 | 05 | MT | MEDICAID | 9600032 | 05 | NC | MEDICAID |