Provider Demographics
NPI:1962038539
Name:MEDI CO
Entity type:Organization
Organization Name:MEDI CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PART OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:SANTANIELLO
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:303-619-1215
Mailing Address - Street 1:11255 KILBERRY WAY
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-3077
Mailing Address - Country:US
Mailing Address - Phone:303-619-1215
Mailing Address - Fax:
Practice Address - Street 1:11255 KILBERRY WAY
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-3077
Practice Address - Country:US
Practice Address - Phone:303-619-1215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-16
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty