1609063825 NPI number — DR. TARRA LOUISA DEITER-ENRIGHT D.O.

Table of content: DR. TARRA LOUISA DEITER-ENRIGHT D.O. (NPI 1609063825)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609063825 NPI number — DR. TARRA LOUISA DEITER-ENRIGHT D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEITER-ENRIGHT
Provider First Name:
TARRA
Provider Middle Name:
LOUISA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
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:
1609063825
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/27/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1515 WYNKOOP ST
Provider Second Line Business Mailing Address:
SUITE 360
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80202-5560
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-243-5010
Provider Business Mailing Address Fax Number:
303-389-9332

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 PRAIRIE CENTER PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRIGHTON
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80601-4006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-519-0842
Provider Business Practice Location Address Fax Number:
303-498-2189
Provider Enumeration Date:
10/02/2007

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: 208M00000X , with the licence number:  48647 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X , with the licence number: 48647 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 50734555 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 271559YK1C . This is a "MEDICARE PTAN FOR SOUND FOR CENTURA" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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