Basic Information
| Provider Information | |||||||||
| NPI: | 1487696969 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HIGHLANDS RANCH HEALTHCARE LLC | ||||||||
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| OtherOrganizationName: | MEDEXPRESS URGENT CARE - LAKEWOOD | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 720 S COLORADO BLVD | ||||||||
| Address2: | SUITE 450S | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802461904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037582800 | ||||||||
| FaxNumber: | 3037582801 | ||||||||
| Practice Location | |||||||||
| Address1: | 605 PARFET ST | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802155576 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034623627 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2006 | ||||||||
| LastUpdateDate: | 05/27/2010 | ||||||||
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| AuthorizedOfficialLastName: | AMSTEIN | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR 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 | 09420827 | 05 | CO | MEDICAID |