1194936906 NPI number — HEART CENTER A PROFESSIONAL LLP

Table of content: (NPI 1194936906)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194936906 NPI number — HEART CENTER A PROFESSIONAL LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEART CENTER A PROFESSIONAL LLP
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:
1194936906
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/13/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
525 N FOOTE AVE
Provider Second Line Business Mailing Address:
309
Provider Business Mailing Address City Name:
COLORADO SPRINGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80909-4554
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-475-2794
Provider Business Mailing Address Fax Number:
719-475-1458

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
525 N FOOTE AVE
Provider Second Line Business Practice Location Address:
309
Provider Business Practice Location Address City Name:
COLORADO SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80909-4554
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-475-2794
Provider Business Practice Location Address Fax Number:
719-475-1458
Provider Enumeration Date:
05/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JENSEN
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
RAE
Authorized Official Title or Position:
DR
Authorized Official Telephone Number:
719-475-2794

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 04023875 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 54583 . This is a "BCBS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: CC9064 . This is a "MEMORIAL HEALTH SYSTEMS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 16559264 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: C810432 . This is a "MEMORIAL HEALTH SYSTEMS" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: CG9404 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 01237551 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100144980 , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: CC5654 . This is a "MEMORIAL HEALTH SYSTEMS" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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