1497798961 NPI number — ROBERT G KILBOURN M.D., PHD

Table of content: ROBERT G KILBOURN M.D., PHD (NPI 1497798961)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497798961 NPI number — ROBERT G KILBOURN M.D., PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KILBOURN
Provider First Name:
ROBERT
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D., PHD
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:
1497798961
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/07/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1927
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAND JUNCTION
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81502-1927
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-986-3622
Provider Business Mailing Address Fax Number:
970-683-5249

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 S 5TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTROSE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81401-5711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-240-7242
Provider Business Practice Location Address Fax Number:
970-240-7793
Provider Enumeration Date:
06/13/2006

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: 207RH0003X , with the licence number:  G9913 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0003X , with the licence number: 46571 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P00670077 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 81509847 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100448301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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