| |
6726 S Revere Pkwy Ste 180 Centennial CO 80112-3962 | |
(720) 681-6170 | |
Not Available |
Full Name | |
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Speciality | Family Medicine |
Location | 6726 S Revere Pkwy Ste 180, Centennial, Colorado |
Authorized Official Name and Position | Jeff Selano (OWNER/CEO) |
Authorized Official Contact | 7206816170 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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6726 S Revere Pkwy Ste 180 Centennial CO 80112-3962 Ph: (720) 681-6170 | 6726 S Revere Pkwy Ste 180 Centennial CO 80112-3962 Ph: (720) 681-6170 |
NPI Number | 1710534524 |
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Provider Enumeration Date | 08/26/2019 |
Last Update Date | 03/07/2022 |
Medicare PECOS PAC ID | 4183057243 |
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Medicare Enrollment ID | O20191203001521 |
Identifier | Type | State | Issuer |
---|---|---|---|
1710534524 | NPI | - | NPPES |
9000201584 | Medicaid | CO |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
332B00000X | Durable Medical Equipment & Medical Supplies | (* (Not Available)) | Secondary |
Provider Name | Ruth A Vanderkooi |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1174567861 PECOS PAC ID: 7517952096 Enrollment ID: I20040415000251 |
Provider Name | Kirk E Mitchell |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1811149685 PECOS PAC ID: 7517016264 Enrollment ID: I20110616000049 |
Provider Name | Rosha Dhakal |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1871136994 PECOS PAC ID: 4385072743 Enrollment ID: I20200318000195 |
Provider Name | Jeff L Selano |
---|---|
Provider Type | Practitioner - Chiropractic |
Provider Identifiers | NPI Number: 1780708461 PECOS PAC ID: 6204888035 Enrollment ID: I20200928000230 |
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