1215149463 NPI number — VASSILY T ELIOPOULOS MD

Table of content: ANGELICA PEARL MA, LPC (NPI 1811463011)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215149463 NPI number — VASSILY T ELIOPOULOS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ELIOPOULOS
Provider First Name:
VASSILY
Provider Middle Name:
T
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1215149463
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3 SUPERIOR DR STE 225
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUPERIOR
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80027-8661
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-414-2083
Provider Business Mailing Address Fax Number:
303-414-2042

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3 SUPERIOR DR STE 225
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUPERIOR
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80027-8661
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-414-2083
Provider Business Practice Location Address Fax Number:
303-414-2042
Provider Enumeration Date:
05/03/2007

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: 207P00000X , with the licence number:  50371 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 24551830 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 20326023101 . This is a "PACIFICARE SECURE HORIZONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 605960009 . This is a "USDLAB" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".
  • Identifier: P01075423 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1215149463 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 315252 . This is a "BSWY" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".




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