1770754004 NPI number — DENVER NEPHROLOGISTS, PC

Table of content: (NPI 1770754004)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770754004 NPI number — DENVER NEPHROLOGISTS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DENVER NEPHROLOGISTS, PC
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:
COLORADO KIDNEY CARE
Provider Other Organization Name Type Code:
3
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:
1770754004
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/25/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
130 RAMPART WAY
Provider Second Line Business Mailing Address:
SUITE 300B
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80230-6051
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-327-4700
Provider Business Mailing Address Fax Number:
303-327-4711

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1411 S POTOMAC STREET
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
AURORA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80012-4536
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-755-7681
Provider Business Practice Location Address Fax Number:
303-755-9167
Provider Enumeration Date:
03/14/2008

Additional Information

Authorized Official

Authorized Official Last Name:
IRWIN
Authorized Official First Name:
ELIZABETH
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF OPERATIONS
Authorized Official Telephone Number:
303-327-4700

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 05274737 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: CT0364 . This is a "RAIROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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