1477885895 NPI number — HEALTHY Z OSTEOPATHIC FAMILY MEDICINE, PLLC

Table of content: (NPI 1477885895)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477885895 NPI number — HEALTHY Z OSTEOPATHIC FAMILY MEDICINE, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTHY Z OSTEOPATHIC FAMILY MEDICINE, PLLC
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:
BOULDER OSTEOPATHIC FAMILY MEDICINE
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:
1477885895
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/27/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2910 STANFORD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOULDER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80305-5341
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
720-259-4609
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
350 S BROADWAY ST.
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
BOULDER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80305-3304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-259-4609
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/10/2010

Additional Information

Authorized Official

Authorized Official Last Name:
VANZURA
Authorized Official First Name:
ERIC
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN MEMBER
Authorized Official Telephone Number:
720-259-4609

Provider Taxonomy Codes

  • Taxonomy code: 204D00000X ; 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: "Y" .
  • Taxonomy code: 2081N0008X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 27625737 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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