1083826960 NPI number — DOUGLAS C MITCHELL MD PROFESSIONAL

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083826960 NPI number — DOUGLAS C MITCHELL MD PROFESSIONAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOUGLAS C MITCHELL MD PROFESSIONAL
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:
1083826960
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/17/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 668
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARVADA
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80001-0668
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-422-9438
Provider Business Mailing Address Fax Number:
303-422-9474

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1551 PROFESSIONAL LN
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
LONGMONT
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80501-6972
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-494-3200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MITCHELL
Authorized Official First Name:
DOUGLAS
Authorized Official Middle Name:
C
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
303-422-9438

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 54781809 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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