1598728677 NPI number — LUANN KAY HENTZ MA, LP

Table of content: (NPI 1609640002)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598728677 NPI number — LUANN KAY HENTZ MA, LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HENTZ
Provider First Name:
LUANN
Provider Middle Name:
KAY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, LP
Provider Gender Code:
F

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:
1598728677
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
32 NORSE LN
Provider Second Line Business Mailing Address:
04
Provider Business Mailing Address City Name:
KEYSTONE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80435-7660
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-333-0734
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 THIRD AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRISCO
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80443
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-333-0734
Provider Business Practice Location Address Fax Number:
970-668-3389
Provider Enumeration Date:
04/10/2006

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: 103T00000X , with the licence number:  LP0732 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 8F78HE . This is a "BLUECROSS/BLUESHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 745052400 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: HP51217 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 928011033387 . This is a "PREFERREDONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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