1811999758 NPI number — HEART CENTER OF THE ROCKIES CATH LAB LLC

Table of content: (NPI 1811999758)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811999758 NPI number — HEART CENTER OF THE ROCKIES CATH LAB LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEART CENTER OF THE ROCKIES CATH LAB LLC
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:
1811999758
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2121 E HARMONY RD
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
FORT COLLINS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80528-3400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-297-6866
Provider Business Mailing Address Fax Number:
970-297-6862

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2500 ROCKY MOUNTAIN AVE
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-624-1756
Provider Business Practice Location Address Fax Number:
970-624-1792
Provider Enumeration Date:
08/11/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RICHARDSON
Authorized Official First Name:
DALE
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
970-297-6931

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  31863 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0011X , with the licence number: 31863 , 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: 25139347 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: HE642103 . This is a "ANTHEM BCBS" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".