1437130895 NPI number — DR. KENNETH W ELKINGTON MD

Employer Identification Number (EIN)	:
Provider Organization Name (Legal Business Name)	:
Provider Last Name (Legal Name)	:	ELKINGTON
Provider First Name	:	KENNETH
Provider Middle Name	:	W
Provider Name Prefix Text	:	DR.
Provider Name Suffix Text	:
Provider Credential Text	:	MD
Provider Gender Code	:	M

Provider Other Organization Name	:
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Provider Other Last Name	:
Provider Other First Name	:
Provider Other Middle Name	:
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Provider Other Name Suffix Text	:
Provider Other Credential Text	:
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NPI Number	:	1437130895
Entity Type Code	:	Individual
Replacement NPI	:
Last Update Date	:	12/07/2007
NPI Deactivation Reason Code	:
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Provider First Line Business Mailing Address	:	1600 23RD AVE
Provider Second Line Business Mailing Address	:
Provider Business Mailing Address City Name	:	GREELEY
Provider Business Mailing Address State Name	:	CO
Provider Business Mailing Address Postal Code	:	806346070
Provider Business Mailing Address Country Code	:	US
Provider Business Mailing Address Telephone Number	:	9703562424
Provider Business Mailing Address Fax Number	:	9703462828

Provider First Line Business Practice Location Address	:	1600 23RD AVE
Provider Second Line Business Practice Location Address	:
Provider Business Practice Location Address City Name	:	GREELEY
Provider Business Practice Location Address State Name	:	CO
Provider Business Practice Location Address Postal Code	:	806346070
Provider Business Practice Location Address Country Code	:	US
Provider Business Practice Location Address Telephone Number	:	9703562424
Provider Business Practice Location Address Fax Number	:	9703462828
Provider Enumeration Date	:	11/10/2005

Authorized Official Last Name	:
Authorized Official First Name	:
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• Taxonomy code: 207V00000X , with the licence number:  45644 , registered in the state of CO .

• Identifier: 65831764 , issued by the state of ( CO ) . This identifiers is of the category "".
• Identifier: E31259 . This identifiers is of the category "".
• Identifier: C808668 , issued by the state of ( CO ) . This identifiers is of the category "".