Basic Information
| Provider Information | |||||||||
| NPI: | 1518141761 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEALTHONE CLINIC SERVICES - PRIMARY CARE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2000 HEALTH PARK DR | ||||||||
| Address2: | |||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370274525 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153725426 | ||||||||
| FaxNumber: | 8668314898 | ||||||||
| Practice Location | |||||||||
| Address1: | 4545 E 9TH AVE STE 610 | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802203905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033298998 | ||||||||
| FaxNumber: | 3033881865 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/24/2007 | ||||||||
| LastUpdateDate: | 08/31/2021 | ||||||||
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| AuthorizedOfficialLastName: | SMITHAM | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | DVP/AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 3035848119 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/31/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 261Q00000X | N | Ambulatory Health Care Facilities | Clinic/Center | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 31433367 | 05 | CO | MEDICAID | 39771571 | 05 | CO | MEDICAID | 73570281 | 05 | CO | MEDICAID | 07709773 | 05 | CO | MEDICAID | 13401548 | 05 | CO | MEDICAID | 65724577 | 05 | CO | MEDICAID | 34758551 | 05 | CO | MEDICAID | 31930743 | 05 | CO | MEDICAID | 60827211 | 05 | CO | MEDICAID | 30136253 | 05 | CO | MEDICAID | 27302270 | 05 | CO | MEDICAID | 46684069 | 05 | CO | MEDICAID | 98059378 | 05 | CO | MEDICAID |