Organization
IV NUTRITION OF WASH PARK
Active
Other names
IV Nutrition of Wash Park, LLC, IV Nutrition of Wash Park
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EDMOND TERRILL JOHNSON (MR)
(172) 072-7350
Entity
Organization
Contact information
Practice address
1211 E ALAMEDA AVE, DENVER, CO 80209-2420
(720) 259-4404
Mailing address
1211 E ALAMEDA AVE, DENVER, CO 80209-2420
(720) 259-4404
Taxonomy
Speciality
Code
Description
License number
State
261QI0500X
Infusion Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
682
682
CO
Enumeration date
02/21/2023
Last updated
02/21/2023
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