1124024799 NPI number — CREEKSIDE ENDOCRINE ASSOCIATES, PC

Table of content: (NPI 1124024799)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124024799 NPI number — CREEKSIDE ENDOCRINE ASSOCIATES, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CREEKSIDE ENDOCRINE ASSOCIATES, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1124024799
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/18/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4101 E. LOUISIANA AVE
Provider Second Line Business Mailing Address:
STE 200
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80246-3431
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-388-6410
Provider Business Mailing Address Fax Number:
303-388-1069

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4101 E. LOUISIANA AVE
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80246-3431
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-388-6410
Provider Business Practice Location Address Fax Number:
303-388-1069
Provider Enumeration Date:
06/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ZEMEL
Authorized Official First Name:
LEONARD
Authorized Official Middle Name:
R.
Authorized Official Title or Position:
OWNER - PHYSICIAN
Authorized Official Telephone Number:
303-388-6410

Provider Taxonomy Codes

  • Taxonomy code: 207RE0101X , with the licence number:  27647 , 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: 60089024 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: DD3981 . This is a "RR MEDICARE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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