1225288624 NPI number — JORDAN MUELL PA

Table of content: JORDAN MUELL PA (NPI 1225288624)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225288624 NPI number — JORDAN MUELL PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MUELL
Provider First Name:
JORDAN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
F

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:
1225288624
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/20/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
550 S WADSWORTH BLVD
Provider Second Line Business Mailing Address:
SUITE 410
Provider Business Mailing Address City Name:
LAKEWOOD
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80226-3111
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-202-1280
Provider Business Mailing Address Fax Number:
303-202-1281

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2551 W. 84TH AVE.
Provider Second Line Business Practice Location Address:
EMERGENCY DEPARTMENT
Provider Business Practice Location Address City Name:
WESTMINSTER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-426-2020
Provider Business Practice Location Address Fax Number:
303-426-2164
Provider Enumeration Date:
09/23/2008

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: 363A00000X , with the licence number:  2610 , 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: 13922742 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00806240 . This is a "RR MEDICARE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".