1235242843 NPI number — MRS. REBECCA L ISAACSON PA

Table of content: MRS. REBECCA L ISAACSON PA (NPI 1235242843)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235242843 NPI number — MRS. REBECCA L ISAACSON PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ISAACSON
Provider First Name:
REBECCA
Provider Middle Name:
L
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA
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:
1235242843
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4900 S MONACO ST
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80237-3486
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-645-0090
Provider Business Mailing Address Fax Number:
303-645-0092

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10103 RIDGEGATE PKWY STE 103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONE TREE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80124-5524
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-645-0090
Provider Business Practice Location Address Fax Number:
303-645-0092
Provider Enumeration Date:
08/16/2006

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: 363A00000X , with the licence number:  PA2268 , 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: 10026281000 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10026283100 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10026280600 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10026280800 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1982948089 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10026280700 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 201014330A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 58582037 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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