1255374849 NPI number — LOWELL ANDERSON-REITZ NP

Table of content: LOWELL ANDERSON-REITZ NP (NPI 1255374849)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255374849 NPI number — LOWELL ANDERSON-REITZ NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANDERSON-REITZ
Provider First Name:
LOWELL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
REITZ
Provider Other First Name:
LOWELL
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
NP
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1255374849
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/29/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9049
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOULDER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80301-9049
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-415-7610
Provider Business Mailing Address Fax Number:
303-415-7618

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4747 ARAPAHOE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOULDER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80303-1131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-415-7610
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/13/2006

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: 207QH0002X , with the licence number:  0001875 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: APN.0001875-NP , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X , with the licence number: 0001875 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X , with the licence number: APN-0001875-NP , 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: 163236602 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 163236603 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9000151171 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".