Provider Demographics
NPI:1053981902
Name:HEALOGICS SPECIALTY PHYSICIANS OF COLORADO-PROFESSIONAL, LLC
Entity type:Organization
Organization Name:HEALOGICS SPECIALTY PHYSICIANS OF COLORADO-PROFESSIONAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-446-3519
Mailing Address - Street 1:PO BOX 645743
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45264-6018
Mailing Address - Country:US
Mailing Address - Phone:855-689-5105
Mailing Address - Fax:904-446-3032
Practice Address - Street 1:1950 MOUNTAIN VIEW AVE
Practice Address - Street 2:4 WEST
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501
Practice Address - Country:US
Practice Address - Phone:720-652-8850
Practice Address - Fax:720-652-8856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric MedicineGroup - Multi-Specialty