1376912931 NPI number — PINNACLE MEDICAL PARTNERS II, LLC

Table of content: (NPI 1376912931)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376912931 NPI number — PINNACLE MEDICAL PARTNERS II, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PINNACLE MEDICAL PARTNERS II, LLC
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:
SOUTH DENVER OBGYN & MIDWIVES
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:
1376912931
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8055 E TUFTS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80237-2854
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-357-2559
Provider Business Mailing Address Fax Number:
720-572-5112

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7335 S PIERCE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LITTLETON
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80128-4571
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-979-7200
Provider Business Practice Location Address Fax Number:
303-933-5265
Provider Enumeration Date:
09/24/2015

Additional Information

Authorized Official

Authorized Official Last Name:
CHACON-JARAMILLO
Authorized Official First Name:
CANDICE
Authorized Official Middle Name:
R
Authorized Official Title or Position:
CREDENTIALING SPECIALIST
Authorized Official Telephone Number:
720-439-2456

Provider Taxonomy Codes

  • Taxonomy code: 176B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LW0102X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LX0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 9000152829 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9000152759 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9000152822 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9000152828 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9000152831 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9000152821 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 475347 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9000152941 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9000153112 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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