Basic Information
| Provider Information | |||||||||
| NPI: | 1639376585 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEALTHONE CLINIC SERVICES-SURGICAL SPECIALTIES 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: | 1601 E 19TH AVE STE 5100 | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802181254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033019014 | ||||||||
| FaxNumber: | 3038320988 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2007 | ||||||||
| LastUpdateDate: | 01/21/2020 | ||||||||
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| AuthorizedOfficialLastName: | SMITHAM | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3035848119 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | N | Ambulatory Health Care Facilities | Clinic/Center | 208600000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 51131030 | 05 | CO | MEDICAID | 61923249 | 05 | CO | MEDICAID | 97427055 | 05 | CO | MEDICAID | 94775753 | 05 | CO | MEDICAID | 12652776 | 05 | CO | MEDICAID | 16558855 | 05 | CO | MEDICAID | 75732238 | 05 | CO | MEDICAID | 81654251 | 05 | CO | MEDICAID |