TAKE TWO HEALTH PC NPI 1720503139

NPI Information

NPI: 1720503139
Provider Name: TAKE TWO HEALTH PC
Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

CLIA Number: 06D2140166

Address:
2503 WALNUT ST STE 200
BOULDER, CO
ZIP 80302
Phone: (303) 557-2250
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TAKE TWO HEALTH PC is a primary care clinic center in Boulder, CO. TAKE TWO HEALTH PC NPI is 1720503139. The provider is registered as an organization entity type.

The provider's business location address is:

2503 WALNUT ST STE 200
BOULDER, CO
ZIP 80302-745
Phone: (303) 557-2250
Fax: (303) 325-7688

The provider's authorized official is Leto Quarles .
The authorized official title is Physician Ceo and has the following contact phone number (303) 557-2250.

The CLIA number assigned to this NPI record is 06D2140166 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/7/2017 and was last updated on 8/7/2017.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QP2300X	Clinic/Center	Primary Care	DR-45461	COLORADO	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	57820511	MEDICAID	COLORADO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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