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Contact Information

FORM MEDICAL, PLLC
1525 RALEIGH ST STE 220
DENVER, CO80204-1374
 Phone: 720-370-9559
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Neuromuscular Medicine

2081N0008X 25 Physician/Physical Medicine and Rehabilitation
Indicates primary specialty

NPI Profile & details for FORM MEDICAL, PLLC

NPI # 1831616390
LBN Legal business name FORM MEDICAL, PLLC
Authorized official JESSICA KELNER - (PHYSICIAN/MANAGER)
Entity Organization
Organization subpart 1 No
Enumeration date 08/25/2017
Last updated 07/21/2022 - About 4 years ago
Identifiers
CO License # DR.0058123
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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