1831135391 NPI number — COLORADO TRAUMA SERVICES PC

Table of content: (NPI 1831135391)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831135391 NPI number — COLORADO TRAUMA SERVICES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLORADO TRAUMA SERVICES 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:
1831135391
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/13/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4350 WADSWORTH BLVD STE 401
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHEAT RIDGE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80033-4638
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
720-996-0780
Provider Business Mailing Address Fax Number:
303-800-8381

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4350 WADSWORTH BLVD STE 401
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHEAT RIDGE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80033-4638
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-996-0780
Provider Business Practice Location Address Fax Number:
303-800-8381
Provider Enumeration Date:
06/22/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ANKERSEN
Authorized Official First Name:
LARS
Authorized Official Middle Name:
C
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
720-996-0780

Provider Taxonomy Codes

  • Taxonomy code: 2086S0127X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 612034501 . This is a "DEPT OF LABOR - SALIDA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 68228066 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 612034500 . This is a "DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".