1578642922 NPI number — CONSULTANTS IN NEPHROLOGY AND HYPERTENSION PROFESSIONAL LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578642922 NPI number — CONSULTANTS IN NEPHROLOGY AND HYPERTENSION PROFESSIONAL LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONSULTANTS IN NEPHROLOGY AND HYPERTENSION PROFESSIONAL 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:
1578642922
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/05/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4940
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68104-0940
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-697-1636
Provider Business Mailing Address Fax Number:
303-805-9948

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9397 CROWN CREST BLVD STE 401
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARKER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80138-8789
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-697-1636
Provider Business Practice Location Address Fax Number:
303-805-9948
Provider Enumeration Date:
11/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DOMINGUEZ
Authorized Official First Name:
OSCAR
Authorized Official Middle Name:
G
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
303-697-1636

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  37995 , 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: 42289319 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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