Organization
VAXCARE COLORADO LLC
Active
Parent organization
VAXCARE CORPORATION
Organization subpart
Yes
Provider details
NPI number
Legal business name
VAXCARE CORPORATION
Authorized official
CASEY DELOACH (MANAGER)
(888) 829-8550
Entity
Organization
Contact information
Practice address
6005 DELMONICO DR, SUITE 150, COLORADO SPRINGS, CO 80919-2237
(407) 480-5986
Mailing address
3113 LAWTON RD, SUITE 250, ORLANDO, FL 32803-3531
(407) 480-5986
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PHC059
MEDICARE PTAN
—
Enumeration date
05/12/2015
Last updated
05/12/2015
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