1710110457 NPI number — MR. AMBRISH M PATEL PA-C

Table of content: MR. AMBRISH M PATEL PA-C (NPI 1710110457)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710110457 NPI number — MR. AMBRISH M PATEL PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PATEL
Provider First Name:
AMBRISH
Provider Middle Name:
M
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
M

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:
1710110457
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/27/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2695 ROCKY MOUNTAIN AVE
Provider Second Line Business Mailing Address:
SUITE 150
Provider Business Mailing Address City Name:
LOVELAND
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80538-8702
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-624-4443
Provider Business Mailing Address Fax Number:
970-490-4175

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5050 POWDERHOUSE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHEYENNE
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82009-4800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-634-1311
Provider Business Practice Location Address Fax Number:
307-634-1271
Provider Enumeration Date:
08/28/2009

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: 363AM0700X , with the licence number:  PA06310 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: PT605 , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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