Basic Information
| Provider Information | |||||||||
| NPI: | 1275787434 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HIGHLANDS RANCH HEALTHCARE LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MEDEXPRESS URGENT CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 720 S COLORADO BLVD STE 450S | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802461939 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037582800 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1050 W 104TH AVE # B | ||||||||
| Address2: | |||||||||
| City: | NORTHGLENN | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802343802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034803627 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2008 | ||||||||
| LastUpdateDate: | 05/27/2010 | ||||||||
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| AuthorizedOfficialLastName: | AMSTEIN | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR, BUSINESS OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 3037582800 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
ID Information
| ID | Type | State | Issuer | Description | 87354748 | 05 | CO | MEDICAID |