1588774269 NPI number — ALTHEA C M SOBEL M.D.

Table of content: ALTHEA C M SOBEL M.D. (NPI 1588774269)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588774269 NPI number — ALTHEA C M SOBEL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOBEL
Provider First Name:
ALTHEA
Provider Middle Name:
C M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SOBEL
Provider Other First Name:
CANDACE
Provider Other Middle Name:
MOSELEY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1588774269
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/31/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2115 STUART AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALAMOSA
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81101-2269
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-589-8005
Provider Business Mailing Address Fax Number:
719-589-8023

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2115 STUART AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALAMOSA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81101-2269
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-589-8005
Provider Business Practice Location Address Fax Number:
719-589-8023
Provider Enumeration Date:
08/30/2006

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: 207R00000X , with the licence number:  46825 , 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: 840255530073 . This is a "ROCKY MOUNTAIN HEALTH PLANS" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 646100 . This is a "FIRSTGUARD" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 25127035 . This is a "BCBS KANSAS CITY" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 100320250A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 203800412 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 29054788 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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