| South Denver Physicians Pllc | |
|
13111 E Briarwood Ave #370 Centennial CO 80112 | |
| (720) 441-4410 | |
| (888) 474-7158 |
| Full Name | South Denver Physicians Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 13111 E Briarwood Ave, Centennial, Colorado |
| Authorized Official Name and Position | Dmitriy I Pales (SOLE MEMBER) |
| Authorized Official Contact | 7204414410 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| South Denver Physicians Pllc 13111 E Briarwood Ave Suite #370 Centennial CO 80112-3930 Ph: (720) 441-4410 | South Denver Physicians Pllc 13111 E Briarwood Ave #370 Centennial CO 80112 Ph: (720) 441-4410 |
| NPI Number | 1124463161 |
|---|---|
| Provider Enumeration Date | 05/03/2013 |
| Last Update Date | 03/13/2014 |
| Medicare PECOS PAC ID | 4183852684 |
|---|---|
| Medicare Enrollment ID | O20140108000201 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124463161 | NPI | - | NPPES |
| 148761 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | 47080 (Colorado) | Secondary |
| 207R00000X | Internal Medicine | 46797 (Colorado) | Primary |
| Provider Name | Dmitriy I Pales |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1548282700 PECOS PAC ID: 9335215250 Enrollment ID: I20080829000089 |
| Provider Name | Elina Pales |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1386746949 PECOS PAC ID: 7113922279 Enrollment ID: I20090317000223 |
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