1376563353 NPI number — DR. ROBERT J VANGEMERT M.D.

Table of content: DR. ROBERT J VANGEMERT M.D. (NPI 1376563353)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376563353 NPI number — DR. ROBERT J VANGEMERT M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VANGEMERT
Provider First Name:
ROBERT
Provider Middle Name:
J
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:
1376563353
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/30/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2233 E. MAIN STREET
Provider Second Line Business Mailing Address:
BUSINESS OPTIONS MEDICAL BUILDING
Provider Business Mailing Address City Name:
MONTROSE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81401-3831
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-765-0810
Provider Business Mailing Address Fax Number:
970-497-8410

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
308 MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OLATHE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81425-0529
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-323-6141
Provider Business Practice Location Address Fax Number:
970-323-6117
Provider Enumeration Date:
07/20/2006

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: 207Q00000X , with the licence number:  21454 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X , with the licence number: 16752 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 840874926001 . This is a "ROCKY MOUNTAIN HEALTHPLAN" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 01214543 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: RO 666431 . This is a "BLUE CROSS" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 16752 . This is a "HI STATE LISENCE" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 453647YS6E . This is a "MEDICARE B PTAN FOR RIVER VALLEY FAMILY HEALTH CENTER" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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