1083064711 NPI number — COLORADO PERMANENTE MEDICAL GROUP, PC

Table of content: (NPI 1083064711)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083064711 NPI number — COLORADO PERMANENTE MEDICAL GROUP, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLORADO PERMANENTE MEDICAL GROUP, PC
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:
1083064711
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10350 E DAKOTA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80247-1314
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-344-7212
Provider Business Mailing Address Fax Number:
303-344-7646

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
215 S PARKSIDE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLORADO SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80910-3131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-338-3800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/14/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HINSKTON
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
CPMG MEDICARECOMPLIANCE COORDINATOR
Authorized Official Telephone Number:
303-344-7212

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RR0500X , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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