1093772550 NPI number — JAMES M BLATCHFORD R.PSG.T , CRT

Table of content: JAMES M BLATCHFORD R.PSG.T , CRT (NPI 1093772550)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093772550 NPI number — JAMES M BLATCHFORD R.PSG.T , CRT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLATCHFORD
Provider First Name:
JAMES
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
R.PSG.T , CRT
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:
1093772550
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9233 PARK MEADOWS DR
Provider Second Line Business Mailing Address:
SUITE 214
Provider Business Mailing Address City Name:
LONE TREE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80124-5426
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
720-874-9622
Provider Business Mailing Address Fax Number:
720-874-9623

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9233 PARK MEADOWS DR
Provider Second Line Business Practice Location Address:
SUITE 214
Provider Business Practice Location Address City Name:
LONE TREE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80124-5426
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-874-9622
Provider Business Practice Location Address Fax Number:
720-874-9623
Provider Enumeration Date:
04/27/2006

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: 246Z00000X , with the licence number:  07876480000 , 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: 07876480000 . This is a "SALES TAX LICENSE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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