1720004450 NPI number — NORTH COLORADO MEDICAL CENTER

Table of content: (NPI 1720004450)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720004450 NPI number — NORTH COLORADO MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH COLORADO MEDICAL CENTER
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:
1720004450
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/31/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2901 N CENTRAL AVE STE 160
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85012-2702
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-747-4000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1801 16TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREELEY
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80631-5154
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-352-4121
Provider Business Practice Location Address Fax Number:
970-350-6644
Provider Enumeration Date:
07/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LARAWAY
Authorized Official First Name:
DENNIS
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
602-747-4000

Provider Taxonomy Codes

  • Taxonomy code: 261QS1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: 0180 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 341600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 06060222 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 05001003 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 81608322 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 109616800 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".




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