1508846551 NPI number — ALEX R. CUDKOWICZ, M.D.,P.C.

Table of content: (NPI 1508846551)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508846551 NPI number — ALEX R. CUDKOWICZ, M.D.,P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALEX R. CUDKOWICZ, M.D.,P.C.
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:
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:
1508846551
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/29/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
658 GRASSMERE PARK STE 104
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37211-3683
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-916-3217
Provider Business Mailing Address Fax Number:
615-916-3218

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1011 N MILDRED RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORTEZ
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-565-8482
Provider Business Practice Location Address Fax Number:
970-565-8478
Provider Enumeration Date:
01/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PAPAIOANU
Authorized Official First Name:
ATHANASSIOS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT & CEO
Authorized Official Telephone Number:
615-916-3200

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X , with the licence number:  34477 , 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: 06D2089339 . This is a "CLIA" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 291602679011 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 445066 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: Q4652 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 21901 . This is a "BLUE CROSS/BLUE SHIELD ID" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 74779354 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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