1215082276 NPI number — RANDI M MCVAY M.D.

Table of content: RANDI M MCVAY M.D. (NPI 1215082276)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215082276 NPI number — RANDI M MCVAY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCVAY
Provider First Name:
RANDI
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1215082276
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9397 CROWN CREST BLVD
Provider Second Line Business Mailing Address:
SUITE 220
Provider Business Mailing Address City Name:
PARKER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80138-8575
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-721-1670
Provider Business Mailing Address Fax Number:
303-721-8117

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9397 CROWN CREST BLVD
Provider Second Line Business Practice Location Address:
SUITE 220
Provider Business Practice Location Address City Name:
PARKER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80138-8575
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-721-1670
Provider Business Practice Location Address Fax Number:
303-721-8117
Provider Enumeration Date:
01/23/2007

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: 174400000X , with the licence number:  33201 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: 33201 , 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: 160056849 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 012033 . This is a "KAISER COMMERCIAL NUMBER" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 01332014 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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