Provider Demographics
NPI:1992248728
Name:COLORADO COMPLETE URGENT CARE PHYSICIANS LLC
Entity type:Organization
Organization Name:COLORADO COMPLETE URGENT CARE PHYSICIANS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL COUNCIL
Authorized Official - Prefix:
Authorized Official - First Name:BRAXTON
Authorized Official - Middle Name:
Authorized Official - Last Name:NEIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:871-421-0031
Mailing Address - Street 1:PO BOX 92472
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-0136
Mailing Address - Country:US
Mailing Address - Phone:817-421-0034
Mailing Address - Fax:
Practice Address - Street 1:2035 S PUEBLO BLVD
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81005-2577
Practice Address - Country:US
Practice Address - Phone:817-527-3431
Practice Address - Fax:817-527-3445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-28
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care