Provider Demographics
NPI:1215918586
Name:HEALTHONE CLINIC SERVICES, LLC
Entity type:Organization
Organization Name:HEALTHONE CLINIC SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:BIRMINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-373-7625
Mailing Address - Street 1:1515 WAZEE ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-1478
Mailing Address - Country:US
Mailing Address - Phone:303-534-9550
Mailing Address - Fax:303-932-7805
Practice Address - Street 1:1515 WAZEE ST
Practice Address - Street 2:SUITE D
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-1478
Practice Address - Country:US
Practice Address - Phone:303-534-9550
Practice Address - Fax:303-932-7805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COGR69051526Medicaid
COGR348308Medicare ID - Type Unspecified