Provider Demographics
NPI:1306978481
Name:HELIODROMUS LLC
Entity type:Organization
Organization Name:HELIODROMUS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:CHARLES
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:303-674-1776
Mailing Address - Street 1:15408 W ELLSWORTH DR
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-5053
Mailing Address - Country:US
Mailing Address - Phone:303-674-1776
Mailing Address - Fax:303-479-8541
Practice Address - Street 1:15408 W ELLSWORTH DR
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-5053
Practice Address - Country:US
Practice Address - Phone:303-674-1776
Practice Address - Fax:303-479-8541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO98846367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO801387Medicare PIN
CO801386Medicare PIN