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1555 S Wadsworth Blvd Lakewood CO 80232-6832 | |
(303) 985-1597 | |
(303) 985-2108 |
Full Name | |
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Speciality | General Practice |
Location | 1555 S Wadsworth Blvd, Lakewood, Colorado |
Authorized Official Name and Position | Nathaniel J Moore (OWNER) |
Authorized Official Contact | 7208787055 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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2224 S Fraser St Unit 1 Aurora CO 80014-4548 Ph: (720) 878-7055 | 1555 S Wadsworth Blvd Lakewood CO 80232-6832 Ph: (303) 985-1597 |
NPI Number | 1386854354 |
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Provider Enumeration Date | 05/22/2007 |
Last Update Date | 03/29/2024 |
Identifier | Type | State | Issuer |
---|---|---|---|
1386854354 | NPI | - | NPPES |
96287837 | Medicaid | CO |
Taxonomy | Type | License (State) | Status |
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208D00000X | General Practice | (* (Not Available)) | Primary |
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