Basic Information
| Provider Information | |||||||||
| NPI: | 1437438348 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CONCENTRA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 770 SIMMS ST | ||||||||
| Address2: | |||||||||
| City: | GOLDEN | ||||||||
| State: | CO | ||||||||
| PostalCode: | 804014702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3032396060 | ||||||||
| FaxNumber: | 3032396046 | ||||||||
| Practice Location | |||||||||
| Address1: | 770 SIMMS ST | ||||||||
| Address2: | |||||||||
| City: | GOLDEN | ||||||||
| State: | CO | ||||||||
| PostalCode: | 804014702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3032396060 | ||||||||
| FaxNumber: | 3032396046 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2011 | ||||||||
| LastUpdateDate: | 08/09/2011 | ||||||||
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| AuthorizedOfficialLastName: | MILLER | ||||||||
| AuthorizedOfficialFirstName: | MATT | ||||||||
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| AuthorizedOfficialTitleorPosition: | REGIONAL MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3032396060 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QX0100X | 896 | CO | Y | Ambulatory Health Care Facilities | Clinic/Center | Occupational Medicine |
No ID Information.