1316944283 NPI number — JONATHAN H WOODCOCK MD & ASSOC PC

Table of content: (NPI 1316944283)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316944283 NPI number — JONATHAN H WOODCOCK MD & ASSOC PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JONATHAN H WOODCOCK MD & ASSOC PC
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:
NEUROLOGICAL REHABILITATION RESOURCE PC
Provider Other Organization Name Type Code:
3
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:
1316944283
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/17/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8515 PEARL ST
Provider Second Line Business Mailing Address:
203
Provider Business Mailing Address City Name:
THORNTON
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80229-4809
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-288-7882
Provider Business Mailing Address Fax Number:
303-288-7874

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8515 PEARL ST
Provider Second Line Business Practice Location Address:
203
Provider Business Practice Location Address City Name:
THORNTON
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80229-4809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-288-7882
Provider Business Practice Location Address Fax Number:
303-288-7874
Provider Enumeration Date:
07/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
WOODCOCK
Authorized Official First Name:
JONATHAN
Authorized Official Middle Name:
HUGH
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
303-288-7882

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  29436 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084P0800X , with the licence number: 29436 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 04019857 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: WOL5918 . This is a "ANTHEM BLUE CROSS BLUE SH" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: JOL5908 . This is a "ANTHEM BLUE CROSS BLUE SH" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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