1457335077 NPI number — DENVER EYE SURGERY CENTER, LLC

Table of content: (NPI 1457335077)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457335077 NPI number — DENVER EYE SURGERY CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DENVER EYE SURGERY CENTER, 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:
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:
1457335077
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/18/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13772 DENVER WEST PKWY STE 120
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKEWOOD
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80401-3139
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-279-6600
Provider Business Mailing Address Fax Number:
303-279-9140

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13772 DENVER WEST PKWY
Provider Second Line Business Practice Location Address:
BLDG#55, STE#120
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80401-3139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-279-6600
Provider Business Practice Location Address Fax Number:
303-279-9140
Provider Enumeration Date:
12/06/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BECKER
Authorized Official First Name:
JACKIE
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
303-273-8774

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QS0132X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 04510087 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 427718 . This is a "LEGACY TM" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 490000347 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: CK2878 . This is a "LEGACY JS" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 803688 . This is a "LEGACY NM" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 803092 . This is a "LEGACY RK" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: CK2868 . This is a "LEGACY VC" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com