Basic Information
| Provider Information | |||||||||
| NPI: | 1467081877 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SCL HEALTH MEDICAL GROUP - DENVER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 835 E 18TH AVE STE 110 | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802181024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3038254646 | ||||||||
| FaxNumber: | 3038253215 | ||||||||
| Practice Location | |||||||||
| Address1: | 835 E 18TH AVE STE 110 | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802181024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3038254646 | ||||||||
| FaxNumber: | 3038253215 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2020 | ||||||||
| LastUpdateDate: | 04/07/2020 | ||||||||
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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: | 04/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.