1790495034 NPI number — HOSPITALIST MEDICINE PHYSICIANS OF COLORADO - BRIGHTON, PC

Table of content: IVELISSE PEREZ MATIAS LMSW (NPI 1154292365)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790495034 NPI number — HOSPITALIST MEDICINE PHYSICIANS OF COLORADO - BRIGHTON, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOSPITALIST MEDICINE PHYSICIANS OF COLORADO - BRIGHTON, 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:
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:
1790495034
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/28/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
120 BRENTWOOD COMMONS WAY STE 510
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRENTWOOD
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37027-2028
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-377-1674
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1498 PACIFIC AVE STE 400
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98402-4208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-577-6340
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/28/2022

Additional Information

Authorized Official

Authorized Official Last Name:
HARLAN
Authorized Official First Name:
MELISSA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF PE
Authorized Official Telephone Number:
615-577-6340

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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