1164473682 NPI number — DR. MICHAEL W COATNEY D.O.

Table of content: DR. MICHAEL W COATNEY D.O. (NPI 1164473682)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164473682 NPI number — DR. MICHAEL W COATNEY D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COATNEY
Provider First Name:
MICHAEL
Provider Middle Name:
W
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
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:
1164473682
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27 MONTEBELLO RD
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:
81001-1236
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-545-1530
Provider Business Mailing Address Fax Number:
719-545-2899

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27 MONTEBELLO RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PUEBLO
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81001-1236
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-545-1530
Provider Business Practice Location Address Fax Number:
719-545-2899
Provider Enumeration Date:
05/12/2006

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: 207W00000X , with the licence number:  26757 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207W00000X , with the licence number: A1218-03 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: P00125009 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: CO6757 . This is a "EYEMED EYE CARE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 92072402082 . This is a "EYE SPECIALISTS" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: K2018 . This is a "ANTHEM BCBS" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: NM004B11 . This is a "NEW MEXICO BCBS" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 180008154 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 0452890003 . This is a "MEDICARE DMERC" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 608439600 . This is a "US DEPT OF LABOR WORK COM" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 85432067 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01267574 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0452890001 . This is a "MEDICARE DMERC" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: K2018 . This is a "BCBS FEDERAL" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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