Basic Information
| Provider Information | |||||||||
| NPI: | 1245556091 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEALTHONE CLINIC SERVICES - ORTHOPEDIC SPECIALISTS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4900 S MONACO ST | ||||||||
| Address2: | #210 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802373486 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3035848000 | ||||||||
| FaxNumber: | 3035848141 | ||||||||
| Practice Location | |||||||||
| Address1: | 4900 S MONACO ST | ||||||||
| Address2: | #210 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802373486 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3035848000 | ||||||||
| FaxNumber: | 3035848141 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2010 | ||||||||
| LastUpdateDate: | 05/12/2017 | ||||||||
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| AuthorizedOfficialLastName: | EVANS | ||||||||
| AuthorizedOfficialFirstName: | TODD | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 3035848000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | N | Ambulatory Health Care Facilities | Clinic/Center | 261QM1300X | N | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | 207X00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 23752581 | 05 | CO | MEDICAID | 14203286 | 05 | CO | MEDICAID | 56473362 | 05 | CO | MEDICAID | 129802000 | 05 | WY | MEDICAID | 38882388 | 05 | CO | MEDICAID | 94473889 | 05 | CO | MEDICAID | 1245556091 | 05 | NE | MEDICAID | 96071389 | 05 | CO | MEDICAID | 1245556091 | 05 | WY | MEDICAID | 200685190B | 05 | KS | MEDICAID | 68975287 | 05 | CO | MEDICAID | 94922080 | 05 | CO | MEDICAID | 57327262 | 05 | CO | MEDICAID |