1659318533 NPI number — TOTAL HEALTHCARE

Table of content: (NPI 1659318533)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659318533 NPI number — TOTAL HEALTHCARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOTAL HEALTHCARE
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:
COLORADO SPORTS & SPINE CENTER
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:
1659318533
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 970
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLORADO SPRINGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80901-0970
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-776-8140
Provider Business Mailing Address Fax Number:
719-776-8150

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1625 MEDICAL CENTER PT
Provider Second Line Business Practice Location Address:
SUITE #100
Provider Business Practice Location Address City Name:
COLORADO SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80907-8731
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-475-1405
Provider Business Practice Location Address Fax Number:
719-475-1409
Provider Enumeration Date:
06/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
O'CONNELL
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
RICHARD
Authorized Official Title or Position:
PRESIDENT & CEO
Authorized Official Telephone Number:
719-776-5007

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 07625007 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: CO17570 . This is a "BC/BS" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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