Basic Information
Provider Information
NPI: 1548703226
EntityType: 2
ReplacementNPI:  
OrganizationName: COLORADO COMPLETE URGENT CARE PHYSICIANS LLC
LastName:  
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Mailing Information
Address1: 910 S KIMBALL AVE
Address2: SUITE A
City: SOUTHLAKE
State: TX
PostalCode: 760929005
CountryCode: US
TelephoneNumber: 8174210034
FaxNumber:  
Practice Location
Address1: 14575 W 64TH AVE
Address2: A
City: ARVADA
State: CO
PostalCode: 800043546
CountryCode: US
TelephoneNumber: 8175273431
FaxNumber: 8175273445
Other Information
ProviderEnumerationDate: 11/29/2016
LastUpdateDate: 11/29/2016
NPIDeactivationReasonCode:  
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AuthorizedOfficialLastName: NEIMAN
AuthorizedOfficialFirstName: BRAXTON
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AuthorizedOfficialTitleorPosition: GENERAL COUNCIL
AuthorizedOfficialTelephone: 8714210031
IsSoleProprietor:  
IsOrganizationSubpart: N
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NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QU0200X  Y Ambulatory Health Care FacilitiesClinic/CenterUrgent Care

No ID Information.


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