Basic Information
| Provider Information | |||||||||
| NPI: | 1629168828 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEALTHONE CLINIC SERVICES LLC | ||||||||
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| OtherOrganizationName: | MOUNTAIN VISTA WOMENS CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 720 S COLORADO BLVD | ||||||||
| Address2: | SUITE 220A | ||||||||
| City: | GLENDALE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802461912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3035848231 | ||||||||
| FaxNumber: | 3035848141 | ||||||||
| Practice Location | |||||||||
| Address1: | 701 E HAMPDEN AVE | ||||||||
| Address2: | #110 | ||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801132736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037888808 | ||||||||
| FaxNumber: | 3037886656 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2006 | ||||||||
| LastUpdateDate: | 05/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | KING | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 3035848000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.