1124075965 NPI number — MRS. TORI GAIL OSGOOD NP

Table of content: MRS. TORI GAIL OSGOOD NP (NPI 1124075965)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124075965 NPI number — MRS. TORI GAIL OSGOOD NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OSGOOD
Provider First Name:
TORI
Provider Middle Name:
GAIL
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHARRIER
Provider Other First Name:
TORI
Provider Other Middle Name:
GAIL
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
NP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1124075965
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:
111 S MONROE ST
Provider Second Line Business Mailing Address:
UNIT 105A
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80209-3007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-316-2713
Provider Business Mailing Address Fax Number:
303-316-2713

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
950 BROADWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80203-2706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-813-7698
Provider Business Practice Location Address Fax Number:
303-813-7673
Provider Enumeration Date:
05/27/2006

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: 363LW0102X , with the licence number:  167765 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LW0102X , with the licence number: 671978 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LW0102X , with the licence number: 22463.342 , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LW0102X , with the licence number: R54482 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 41888545 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".