1649927740 NPI number — WESTERN INFECTIOUS DISEASE INFUSION CENTER, 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 1649927740 NPI number — WESTERN INFECTIOUS DISEASE INFUSION CENTER, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WESTERN INFECTIOUS DISEASE INFUSION CENTER, 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:
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:
1649927740
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/09/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3885 UPHAM ST STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHEAT RIDGE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80033-4800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-425-9245
Provider Business Mailing Address Fax Number:
720-974-7431

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1551 PROFESSIONAL LN UNIT 280
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONGMONT
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80501-6965
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-425-9245
Provider Business Practice Location Address Fax Number:
720-600-5140
Provider Enumeration Date:
03/08/2022

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
RUTH
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
303-425-9245

Provider Taxonomy Codes

  • Taxonomy code: 207RI0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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