Provider Demographics
NPI:1871787366
Name:GREEN VALLEY RANCH URGENT CARE CENTER PROF. LLC
Entity type:Organization
Organization Name:GREEN VALLEY RANCH URGENT CARE CENTER PROF. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D./OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AUGUSTINE
Authorized Official - Middle Name:U
Authorized Official - Last Name:OBINNAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-344-3700
Mailing Address - Street 1:4809 ARGONNE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80249-6834
Mailing Address - Country:US
Mailing Address - Phone:303-344-8700
Mailing Address - Fax:303-344-0200
Practice Address - Street 1:4809 ARGONNE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80249-6834
Practice Address - Country:US
Practice Address - Phone:303-344-8700
Practice Address - Fax:303-344-0200
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREEN VALLEY RANCH MEDICAL CLINIC PROF. LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-28
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO36486261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care