1063400166 NPI number — DR. THOMAS A HAFFEY D.O.

Table of content: DR. THOMAS A HAFFEY D.O. (NPI 1063400166)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063400166 NPI number — DR. THOMAS A HAFFEY D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAFFEY
Provider First Name:
THOMAS
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
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:
1063400166
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4900 S MONACO ST STE 210
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80237-3487
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-252-0104
Provider Business Mailing Address Fax Number:
303-920-2181

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9141 GRANT ST
Provider Second Line Business Practice Location Address:
SUITE 140
Provider Business Practice Location Address City Name:
THORNTON
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80229-4374
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-252-0104
Provider Business Practice Location Address Fax Number:
303-252-0127
Provider Enumeration Date:
10/12/2005

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: 207RC0000X , with the licence number:  24470 , 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: 01244706 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 414698YPNQ . This is a "MEDICARE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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