| Provident Senior Health, Inc. | |
|
799 E Hampden Ave Suite 300 Englewood CO 80113-2700 | |
| (303) 493-5270 | |
| (303) 493-5295 |
| Full Name | Provident Senior Health, Inc. |
|---|---|
| Speciality | Internal Medicine |
| Location | 799 E Hampden Ave, Englewood, Colorado |
| Authorized Official Name and Position | Bill Nooning (CEO) |
| Authorized Official Contact | 3034935270 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Provident Senior Health, Inc. Po Box 60 Englewood CO 80151-0060 Ph: (303) 493-5270 | Provident Senior Health, Inc. 799 E Hampden Ave Suite 300 Englewood CO 80113-2700 Ph: (303) 493-5270 |
| NPI Number | 1780640169 |
|---|---|
| Provider Enumeration Date | 04/25/2006 |
| Last Update Date | 08/19/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780640169 | NPI | - | NPPES |
| 25175025 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
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