Basic Information
| Provider Information | |||||||||
| NPI: | 1164195673 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SCL HEALTH MEDICAL GROUP DENVER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 ELDORADO BLVD STE 6300 | ||||||||
| Address2: | |||||||||
| City: | BROOMFIELD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800213422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3032720566 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1606 PRAIRIE CENTER PKWY STE 210 | ||||||||
| Address2: | |||||||||
| City: | BRIGHTON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 806014004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034036688 | ||||||||
| FaxNumber: | 3034036245 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2021 | ||||||||
| LastUpdateDate: | 07/29/2021 | ||||||||
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| AuthorizedOfficialLastName: | MCDANIEL | ||||||||
| AuthorizedOfficialFirstName: | JON | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP FINANCE MEDICAL GROUP | ||||||||
| AuthorizedOfficialTelephone: | 3032720231 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SCL HEALTH FRONT RANGE INC | ||||||||
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| NPICertificationDate: | 07/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.