1700895869 NPI number — DR. BETH ANN HASELHORST MD

Table of content: DR. BETH ANN HASELHORST MD (NPI 1700895869)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700895869 NPI number — DR. BETH ANN HASELHORST MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HASELHORST
Provider First Name:
BETH
Provider Middle Name:
ANN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1700895869
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2250 OAK HILLS DR
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:
80919-3472
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-522-1444
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4102 PINION DR
Provider Second Line Business Practice Location Address:
CADET CLINIC - 10TH MEDICAL GROUP
Provider Business Practice Location Address City Name:
USAF ACADEMY
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80840-4000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-333-5180
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/07/2006

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: 207Q00000X , with the licence number:  44306 , 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)