1720011786 NPI number — BIG THOMPSON MEDICAL GROUP INC

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720011786 NPI number — BIG THOMPSON MEDICAL GROUP INC

Employer Identification Number (EIN):

Provider Organization Name:

BIG THOMPSON MEDICAL GROUP INC

Provider Last Name:

Provider First Name:

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

Provider Gender Code:

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:

1720011786

Entity Type Code:

Organization

Replacement NPI:

Last Update Date:

01/06/2011

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

1627 E 18TH ST

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

LOVELAND

Provider Business Mailing Address State Name:

CO

Provider Business Mailing Address Postal Code:

80538-4209

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

970-663-0135

Provider Business Mailing Address Fax Number:

970-461-1422

Provider First Line Business Practice Location Address:

1627 E 18TH ST

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

LOVELAND

Provider Business Practice Location Address State Name:

CO

Provider Business Practice Location Address Postal Code:

80538-4209

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

970-663-0135

Provider Business Practice Location Address Fax Number:

970-461-1422

Provider Enumeration Date:

07/09/2006

Authorized Official Last Name:

NORMAN

Authorized Official First Name:

EDWARD

Authorized Official Middle Name:

A

Authorized Official Title or Position:

PRESIDENT

Authorized Official Telephone Number:

970-663-0135

• Taxonomy code: 207Q00000X , with the licence number:  19473 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 207R00000X , with the licence number: 37927 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207RA0201X , with the licence number: 18320 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207V00000X , with the licence number: 33354 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 208000000X , with the licence number: 31069 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2084N0400X , with the licence number: 48281 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 208M00000X , with the licence number: 37823 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 261QU0200X , with the licence number: 27598 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 363A00000X , with the licence number: 2059 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 363L00000X , with the licence number: 89947 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 367A00000X , with the licence number: 61438 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 61238864 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
• Identifier: 69579725 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
• Identifier: 97728756 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
• Identifier: 98471881 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
• Identifier: 40757820 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
• Identifier: 12408221 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
• Identifier: 04117040 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
• Identifier: 41736028 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
• Identifier: 49422839 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
• Identifier: 10374523 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
• Identifier: 43222820 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
• Identifier: 71131523 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
• Identifier: 04657045 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
• Identifier: 04005062 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
• Identifier: 17223822 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".