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Organization
KAISER PERMANENTE
Active
Organization
KAISER PERMANENTE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MATTHEW RAYMOND PROVOST RN (REGISTERED NURSE)
(413) 885-0840
Entity
Organization
Contact information
Practice address
1451 24TH STREET, APT 146, DENVER, CO 80205
(413) 885-0840
Mailing address
1451 24TH STREET, APT 146, DENVER, CO 80205
(413) 885-0840
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
1640198
CO
Other
Enumeration date
01/10/2017
Last updated
01/10/2017
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