1629199062 NPI number — CHRMEG MED INC

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 1629199062 NPI number — CHRMEG MED INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHRMEG MED INC
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:
PARKER FAMILY CARE
Provider Other Organization Name Type Code:
3
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:
1629199062
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10259 S. PARKER ROAD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
PARKER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80134
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-805-2273
Provider Business Mailing Address Fax Number:
303-805-2287

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10259 S. PARKER ROAD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
PARKER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-805-2273
Provider Business Practice Location Address Fax Number:
303-805-2287
Provider Enumeration Date:
04/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WEST
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRACTICE OWNER/PHYSICIAN
Authorized Official Telephone Number:
303-805-2273

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  40652 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363AM0700X , with the licence number: 1179 , 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: 40652 . This is a "PHYSICIAN STATE LICENSE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 1790838266 . This is a "NPI FOR MIDLEVEL PROVIDER" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 1179 . This is a "LICENSE FOR MIDLEVEL PROV" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 126549112 . This is a "PHYSICIAN NPI" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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