1023116316 NPI number — DR. JAMES C KARN M.D.

Table of content: DR. JAMES C KARN M.D. (NPI 1023116316)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023116316 NPI number — DR. JAMES C KARN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KARN
Provider First Name:
JAMES
Provider Middle Name:
C
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:
1023116316
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/25/2020
NPI Reactivation Date:
04/21/2020

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 570
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PUEBLO
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81002-0570
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-296-5841
Provider Business Mailing Address Fax Number:
719-542-0746

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
916 INDIANA AVE
Provider Second Line Business Practice Location Address:
STE 120
Provider Business Practice Location Address City Name:
PUEBLO
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81004-3572
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-296-5841
Provider Business Practice Location Address Fax Number:
719-542-0746
Provider Enumeration Date:
09/20/2006

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: 207L00000X , with the licence number:  26023 , 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: 050051084 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 26023 . This is a "COLO STATE LICENSE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: PH18408 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01260231 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: CH6461 . This is a "RR MEDICARE - GROUP" identifier . This identifiers is of the category "OTHER".




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