1215228473 NPI number — DR. THOMAS THEODORE HEACOCK M.D.

Table of content: DR. THOMAS THEODORE HEACOCK M.D. (NPI 1215228473)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215228473 NPI number — DR. THOMAS THEODORE HEACOCK M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEACOCK
Provider First Name:
THOMAS
Provider Middle Name:
THEODORE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1215228473
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/03/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
UCHEALTH PULMONOLOGY CLINIC
Provider Second Line Business Mailing Address:
2121 E HARMONY ROAD SUITE 300
Provider Business Mailing Address City Name:
FORT COLLINS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80528-3403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-224-9102
Provider Business Mailing Address Fax Number:
970-224-9112

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
UCHEALTH PULMONOLOGY CLINIC
Provider Second Line Business Practice Location Address:
2121 E HARMONY ROAD SUITE 300
Provider Business Practice Location Address City Name:
FORT COLLINS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80528-3403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-224-9102
Provider Business Practice Location Address Fax Number:
970-224-9112
Provider Enumeration Date:
04/22/2011

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: 207RP1001X , with the licence number:  A141859 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , with the licence number: DR.0053921 , 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)