Provider Demographics
NPI:1356386221
Name:DENVER UROLOGY CLINIC, P.C.
Entity type:Organization
Organization Name:DENVER UROLOGY CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHAWNA
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROMERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-388-9321
Mailing Address - Street 1:4545 E 9TH AVE
Mailing Address - Street 2:SUITE 480
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-3901
Mailing Address - Country:US
Mailing Address - Phone:303-388-9321
Mailing Address - Fax:303-388-3910
Practice Address - Street 1:4545 E 9TH AVE
Practice Address - Street 2:SUITE 480
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-3901
Practice Address - Country:US
Practice Address - Phone:303-388-9321
Practice Address - Fax:303-388-3910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04724043Medicaid
COC72404Medicare ID - Type Unspecified