1104910181 NPI number — JOSEPH M LOPEZ MD PC

Table of content: (NPI 1104910181)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104910181 NPI number — JOSEPH M LOPEZ MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOSEPH M LOPEZ MD 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:
1104910181
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1136 E STUART ST
Provider Second Line Business Mailing Address:
SUITE 4202
Provider Business Mailing Address City Name:
FT COLLINS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80525
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-221-5925
Provider Business Mailing Address Fax Number:
970-221-5012

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1136 E STUART ST
Provider Second Line Business Practice Location Address:
SUITE 4202
Provider Business Practice Location Address City Name:
FT COLLINS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80525
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-221-5925
Provider Business Practice Location Address Fax Number:
970-221-5012
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LOPEZ
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
970-221-5925

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: PR32757550001 . This is a "CIGNA HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 55181 . This is a "FEDERA BC BS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0004586257 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000585011 . This is a "APWU HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01252378 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: C09900002163 . This is a "SIERRA HEALTH & LIFE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010011909 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 120085BF . This is a "PREFERRED ADMINISTRATIVE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 33143 . This is a "ANTHEM BC BS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0135688 . This is a "MAIL HANDLERS BENEFIT PLA" identifier . This identifiers is of the category "OTHER".




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