1386636843 NPI number — RONALD E WISE MD

Table of content: RONALD E WISE MD (NPI 1386636843)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386636843 NPI number — RONALD E WISE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WISE
Provider First Name:
RONALD
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1386636843
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/28/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 110429
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AURORA
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80042-0429
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-493-7000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1435 WAZEE ST
Provider Second Line Business Practice Location Address:
# 101
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80202-1491
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-299-9473
Provider Business Practice Location Address Fax Number:
303-299-9472
Provider Enumeration Date:
08/19/2005

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: 208600000X , with the licence number:  34013 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207WX0120X , with the licence number: 34013 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207W00000X , with the licence number: 34013 , 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: 1841407392 . This is a "KS NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 41535 . This is a "AVESIS" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 0815699 . This is a "AETNA" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 841353910 . This is a "TAX ID#" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: WI12401 . This is a "CO BLUE SHIELD" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 18827 . This is a "SPECTERA" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: CO4013 . This is a "EYEMED" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 919991020591 . This is a "EYE SPECIALISTS" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 180025514 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 200539900A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 106500 . This is a "KS BLUE SHIELD" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 1340132 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1467405928 . This is a "GROUP NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 34013 . This is a "VISION BENEFITS OF AMER" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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