1821180506 NPI number — PEDIATRIC & ADOLESCENT MEDICINE

Table of content: (NPI 1821180506)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821180506 NPI number — PEDIATRIC & ADOLESCENT MEDICINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEDIATRIC & ADOLESCENT MEDICINE
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:
CROWN POINT PEDIATRICS
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:
1821180506
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/22/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9235 CROWN CREST BLVD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
PARKER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80138-8880
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-695-7667
Provider Business Mailing Address Fax Number:
303-695-8146

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9235 CROWN CREST BLVD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
PARKER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80138-8880
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-695-7667
Provider Business Practice Location Address Fax Number:
303-695-8146
Provider Enumeration Date:
09/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROOS
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
B
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
303-695-7667

Provider Taxonomy Codes

  • Taxonomy code: 2080A0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 04009304 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com