1255513677 NPI number — MARTIN S. BOHM, D.O., PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255513677 NPI number — MARTIN S. BOHM, D.O., PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARTIN S. BOHM, D.O., PLLC
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:
ALPINE MEADOWS MEDICAL CLINIC, PLLC
Provider Other Organization Name Type Code:
3
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:
1255513677
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/03/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2802 MADISON SQUARE DR
Provider Second Line Business Mailing Address:
SUITE 120
Provider Business Mailing Address City Name:
LOVELAND
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80538-3387
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-776-1950
Provider Business Mailing Address Fax Number:
970-776-1954

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2802 MADISON SQUARE DR
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
LOVELAND
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80538-3387
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-776-1950
Provider Business Practice Location Address Fax Number:
970-776-1954
Provider Enumeration Date:
11/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BOHM
Authorized Official First Name:
MARTIN
Authorized Official Middle Name:
SCOTT
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
970-776-1950

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , 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: 44910 . This is a "COLORADO STATE LICENSE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 70123012 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com