1780849620 NPI number — TYLER J GREEN MD

Table of content: TYLER J GREEN MD (NPI 1780849620)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780849620 NPI number — TYLER J GREEN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GREEN
Provider First Name:
TYLER
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
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:
1780849620
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10800 E GEDDES AVE STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ENGLEWOOD
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80112-3895
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-761-9190
Provider Business Mailing Address Fax Number:
720-874-4462

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10800 E GEDDES AVE STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ENGLEWOOD
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80112-3895
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-761-9190
Provider Business Practice Location Address Fax Number:
720-874-4462
Provider Enumeration Date:
07/21/2008

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: 2085R0202X , with the licence number:  04-40433 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 55471 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0204X , with the licence number: DR.0055471 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085R0202X , with the licence number: MD19335 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 30330 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: MD166193 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: NA1215124 . This is a "MEDICARE PIN" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: NA2517101 . This is a "MEDICARE PIN" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 111257111 . This is a "MEDICARE PIN" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 590453YQ3L . This is a "MEDICARE PIN" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 590453YQPG . This is a "MEDICARE PIN" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 1780849620 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: NA1214123 . This is a "MEDICARE PIN" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 590453YQ33 . This is a "MEDICARE PIN" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: KA3249102 . This is a "MEDICARE PIN" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 590453YQN9 . This is a "MEDICARE PIN" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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