| Denver Neurological Clinic Professional Llc | |
|
9980 Park Meadows Dr Ste 100 Lone Tree CO 80124-8404 | |
| (303) 715-9024 | |
| (303) 715-7057 |
| Full Name | Denver Neurological Clinic Professional Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 9980 Park Meadows Dr Ste 100, Lone Tree, Colorado |
| Authorized Official Name and Position | Justin Moon (MANAGING MEMBER) |
| Authorized Official Contact | 3037159024 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Denver Neurological Clinic Professional Llc 9980 Park Meadows Dr Ste 100 Lone Tree CO 80124-8404 Ph: (303) 715-9024 | Denver Neurological Clinic Professional Llc 9980 Park Meadows Dr Ste 100 Lone Tree CO 80124-8404 Ph: (303) 715-9024 |
| NPI Number | 1578744017 |
|---|---|
| Provider Enumeration Date | 11/26/2007 |
| Last Update Date | 08/31/2023 |
| Certification Date | 08/31/2023 |
| Medicare PECOS PAC ID | 1456372770 |
|---|---|
| Medicare Enrollment ID | O20051220000495 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578744017 | NPI | - | NPPES |
| 10733850 | Medicaid | CO | |
| P00361949 | Other | CO | RAILROAD MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0600X | Psychiatry & Neurology - Clinical Neurophysiology | 42593 (Colorado) | Primary |
| Provider Name | Adam Wolff |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1053349597 PECOS PAC ID: 3678474764 Enrollment ID: I20040907000529 |
| Provider Name | Justin S Moon |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1215019609 PECOS PAC ID: 1153422365 Enrollment ID: I20080715000586 |
| Provider Name | Kim Huynh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104396647 PECOS PAC ID: 7315284072 Enrollment ID: I20190204001156 |
| Provider Name | Katie Yates Nading |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053912196 PECOS PAC ID: 0446659775 Enrollment ID: I20210519000103 |
| Provider Name | Dorothy Nguyen-daniels |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1134791452 PECOS PAC ID: 4385049055 Enrollment ID: I20210818001115 |
| Provider Name | Katherine M Riedler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326686353 PECOS PAC ID: 1850783960 Enrollment ID: I20220510001827 |
| Provider Name | Carolyn Schnieders |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548902208 PECOS PAC ID: 7214307446 Enrollment ID: I20230105000578 |
| Provider Name | Linda Hollyman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497447866 PECOS PAC ID: 3971965856 Enrollment ID: I20230809000767 |
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