1720172059 NPI number — THEODORE CLIFFORD NING JR. MD

Table of content: THEODORE CLIFFORD NING JR. MD (NPI 1720172059)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720172059 NPI number — THEODORE CLIFFORD NING JR. MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NING
Provider First Name:
THEODORE
Provider Middle Name:
CLIFFORD
Provider Name Prefix Text:
Provider Name Suffix Text:
JR.
Provider Credential Text:
MD
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:
1720172059
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/27/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
33424 DEEP FOREST RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVERGREEN
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80439-9736
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-670-7171
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 INDIANA ST
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
GOLDEN
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80401-5027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-885-2550
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/03/2006

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: 208800000X , with the licence number:  16283 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208800000X , with the licence number: 042.0012859 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208800000X , with the licence number: DR.0016283 , 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: 1022867 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: Y400137843 . This is a "MEDICARE PTAN LINKED TO CVMC MPG" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 01162833 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com