Provider Demographics
NPI:1053359117
Name:AMERICAS BACK AND NECK CLINIC
Entity type:Organization
Organization Name:AMERICAS BACK AND NECK CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:SHARP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-770-6355
Mailing Address - Street 1:8230 SOUTH COLORADO BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122-3689
Mailing Address - Country:US
Mailing Address - Phone:303-770-6355
Mailing Address - Fax:303-770-5019
Practice Address - Street 1:8230 SOUTH COLORADO BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80122-3689
Practice Address - Country:US
Practice Address - Phone:303-770-6355
Practice Address - Fax:303-770-5019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7330225100000X
CO261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC805927Medicare PIN