| Brian T. Shea Do Llc | |
|
1790 30th St Suite 120 Boulder CO 80301-1022 | |
| (303) 447-0022 | |
| Not Available |
| Full Name | Brian T. Shea Do Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1790 30th St, Boulder, Colorado |
| Authorized Official Name and Position | Brian T Shea (PRESIDENT) |
| Authorized Official Contact | 3034443443 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Brian T. Shea Do Llc Po Box 2086 Fort Collins CO 80522-2086 Ph: (303) 444-3443 | Brian T. Shea Do Llc 1790 30th St Suite 120 Boulder CO 80301-1022 Ph: (303) 447-0022 |
| NPI Number | 1235327198 |
|---|---|
| Provider Enumeration Date | 10/04/2007 |
| Last Update Date | 03/04/2008 |
| Medicare PECOS PAC ID | 7315920212 |
|---|---|
| Medicare Enrollment ID | O20040610001836 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235327198 | NPI | - | NPPES |
| 92021328 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 36013 (Colorado) | Primary |
| Provider Name | Brian T Shea |
|---|---|
| Provider Type | Practitioner - Osteopathic Manipulative Medicine |
| Provider Identifiers | NPI Number: 1396758835 PECOS PAC ID: 0042293946 Enrollment ID: I20080520000316 |
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