1245646942 NPI number — KARMEN THEA MITCHELL MM, MT-BC

Table of content: KARMEN THEA MITCHELL MM, MT-BC (NPI 1245646942)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245646942 NPI number — KARMEN THEA MITCHELL MM, MT-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MITCHELL
Provider First Name:
KARMEN
Provider Middle Name:
THEA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MM, MT-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MORLOCK
Provider Other First Name:
KARMEN
Provider Other Middle Name:
THEA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
BM, BAE
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1245646942
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/02/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3501 S MASON ST
Provider Second Line Business Mailing Address:
UNIT 1
Provider Business Mailing Address City Name:
FORT COLLINS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80525-2627
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-407-9084
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3501 S MASON ST
Provider Second Line Business Practice Location Address:
UNIT 1
Provider Business Practice Location Address City Name:
FORT COLLINS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80525-2627
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-407-9084
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/02/2014

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: 225A00000X , with the licence number:  10628 , 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)





Copyright © 2007-2025 www.npivalidator.com