Provider Demographics
NPI:1366904443
Name:VACCINE HIPPO CO LLC
Entity type:Organization
Organization Name:VACCINE HIPPO CO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:COLUMBUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-829-2968
Mailing Address - Street 1:10040 W CHEYENNE AVE STE 170-146
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-7719
Mailing Address - Country:US
Mailing Address - Phone:702-641-1776
Mailing Address - Fax:
Practice Address - Street 1:200 UNION BLVD STE 311
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1831
Practice Address - Country:US
Practice Address - Phone:866-829-2968
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VACCINE HIPPO, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-05
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty