1699961979 NPI number — KIDNEY ASSOCIATES OF COLORADO

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 1699961979 NPI number — KIDNEY ASSOCIATES OF COLORADO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KIDNEY ASSOCIATES OF COLORADO
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:
6
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:
1699961979
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/19/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
850 E HARVARD AVE
Provider Second Line Business Mailing Address:
SUITE 565
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80210-5073
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-777-3333
Provider Business Mailing Address Fax Number:
303-733-4441

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
850 E HARVARD AVE
Provider Second Line Business Practice Location Address:
SUITE 565
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80210-5073
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-777-3333
Provider Business Practice Location Address Fax Number:
303-733-4441
Provider Enumeration Date:
09/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MARQUEZ
Authorized Official First Name:
AILEEN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CREDENTIALING
Authorized Official Telephone Number:
303-908-4712

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  23822 , 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: 1699961979 . This is a "GROUP NPI" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 58405038 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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