1598742579 NPI number — JAMES M MORTINSEN MD

Table of content: JAMES M MORTINSEN MD (NPI 1598742579)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598742579 NPI number — JAMES M MORTINSEN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORTINSEN
Provider First Name:
JAMES
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1598742579
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/04/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8000 E MAPLEWOOD AVE STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENWOOD VILLAGE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80111-4727
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-785-4700
Provider Business Mailing Address Fax Number:
303-336-8350

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8000 E MAPLEWOOD AVE STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENWOOD VILLAGE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80111-4727
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-785-4700
Provider Business Practice Location Address Fax Number:
303-377-7638
Provider Enumeration Date:
12/29/2005

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: 207L00000X , with the licence number:  31943 , 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: 3506685 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100136110A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01319433 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: S5052 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 102778600 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 84113438513 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 058706501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com