Provider Demographics
NPI:1144644600
Name:CENTENNIAL MEDICAL SERVICES LLC
Entity type:Organization
Organization Name:CENTENNIAL MEDICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHENBECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-870-7446
Mailing Address - Street 1:14100 E ARAPAHOE RD
Mailing Address - Street 2:B110
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-4028
Mailing Address - Country:US
Mailing Address - Phone:720-870-7446
Mailing Address - Fax:720-870-7460
Practice Address - Street 1:10634 AMESBURY WAY
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80126-8043
Practice Address - Country:US
Practice Address - Phone:720-870-7446
Practice Address - Fax:720-870-7460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-04
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty