Basic Information
| Provider Information | |||||||||
| NPI: | 1851030795 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DENVER SPRINGS PHYSICIAN GROUP, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4801 OLYMPIA PARK PLZ STE 1000 | ||||||||
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| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402412090 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4125883546 | ||||||||
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| Practice Location | |||||||||
| Address1: | 401 W HAMPDEN PL STE 200 | ||||||||
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| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801102534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7206440025 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2022 | ||||||||
| LastUpdateDate: | 05/31/2022 | ||||||||
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| AuthorizedOfficialLastName: | WARREN | ||||||||
| AuthorizedOfficialFirstName: | GINA | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR CREDENTIALING | ||||||||
| AuthorizedOfficialTelephone: | 5023813338 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | DENVER SPRINGS, LLC | ||||||||
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| NPICertificationDate: | 05/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.