Provider Demographics
NPI:1699910042
Name:AVICENNA
Entity type:Organization
Organization Name:AVICENNA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:VITALIY
Authorized Official - Middle Name:
Authorized Official - Last Name:BELYAVSKIY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-581-0388
Mailing Address - Street 1:2600 S PARKER RD BLDG 7 UNIT 173
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014
Mailing Address - Country:US
Mailing Address - Phone:720-581-0388
Mailing Address - Fax:
Practice Address - Street 1:2600 S PARKER RD BLDG 7 UNIT 173
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014
Practice Address - Country:US
Practice Address - Phone:720-581-0388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-12
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies