1417119553 NPI number — DR. RYAN NICHOLAS CRETE M.D.

Table of content: DR. RYAN NICHOLAS CRETE M.D. (NPI 1417119553)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417119553 NPI number — DR. RYAN NICHOLAS CRETE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRETE
Provider First Name:
RYAN
Provider Middle Name:
NICHOLAS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1417119553
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/09/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10800 E GEDDES AVE STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ENGLEWOOD
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80112-3895
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-761-9190
Provider Business Mailing Address Fax Number:
720-874-4462

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 ALA MOANA BLVD STE 5B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-761-9190
Provider Business Practice Location Address Fax Number:
720-874-4462
Provider Enumeration Date:
06/30/2008

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: 2085R0202X , with the licence number:  59757 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 04-40698 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 30603 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: MD-15289 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 10026277400 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 627576YQPG . This is a "MEDICARE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 627576ZLJ3 . This is a "MEDICARE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 84089712600 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 111257114 . This is a "MEDICARE" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 627576YQ33 . This is a "MEDICARE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 10026277300 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 627576AE6Y . This is a "MEDICARE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 627576YQN9 . This is a "MEDICARE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 627576ZNTB . This is a "MEDICARE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: H111054 . This is a "MEDICARE" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 10026277700 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 84059792913 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: KA3249105 . This is a "MEDICARE" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 9000156797 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10025709000 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: H104776 . This is a "MEDICARE" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: NA2517105 . This is a "MEDICARE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 10026277500 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10026277800 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com