1659373843 NPI number — DR. VIRGINIA KAREN AUGUSTITUS M.D.

Table of content: DR. VIRGINIA KAREN AUGUSTITUS M.D. (NPI 1659373843)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659373843 NPI number — DR. VIRGINIA KAREN AUGUSTITUS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AUGUSTITUS
Provider First Name:
VIRGINIA
Provider Middle Name:
KAREN
Provider Name Prefix Text:
DR.
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:
AUGUSTITUS
Provider Other First Name:
V.
Provider Other Middle Name:
KAREN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1659373843
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/04/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1707 COLE BLVD
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
GOLDEN
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80401-3220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-716-8013
Provider Business Mailing Address Fax Number:
303-763-5495

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
165 S UNION BLVD
Provider Second Line Business Practice Location Address:
STE 800
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80228-2213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-988-2680
Provider Business Practice Location Address Fax Number:
303-986-8057
Provider Enumeration Date:
06/01/2005

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:  28010 , 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: 01280106 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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