# KAISER PERMANENTE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255877635
- **Authorized official:** MR. MATTHEW RAYMOND PROVOST RN (REGISTERED NURSE)
- **Authorized official phone:** (413) 885-0840

## Contact information

- **Practice address:** 1451 24TH STREET, APT 146, DENVER, CO 80205
- **Practice address phone:** (413) 885-0840
- **Mailing address:** 1451 24TH STREET, APT 146, DENVER, CO 80205
- **Mailing address phone:** (413) 885-0840

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | 1640198 | CO | Yes |

## Other

- **Enumeration date:** 01/10/2017
- **Last updated:** 01/10/2017