1033108915 NPI number — DR. TIMOTHY RAY HURTADO DO

Table of content: DR. TIMOTHY RAY HURTADO DO (NPI 1033108915)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033108915 NPI number — DR. TIMOTHY RAY HURTADO DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HURTADO
Provider First Name:
TIMOTHY
Provider Middle Name:
RAY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033108915
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/02/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2222 N NEVADA AVE
Provider Second Line Business Mailing Address:
FRONT RANGE EMERGENCY SPECIALISTS
Provider Business Mailing Address City Name:
COLORADO SPRINGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80907-6819
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-475-0299
Provider Business Mailing Address Fax Number:
719-475-0414

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2222 N NEVADA AVE
Provider Second Line Business Practice Location Address:
FRONT RANGE EMERGENCY SPECIALISTS
Provider Business Practice Location Address City Name:
COLORADO SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80907-6819
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-475-0299
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/13/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  285 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: 45777 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 24525006 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".