1831185776 NPI number — DR. JOHN A PREVEDEL MD

Table of content: DR. JOHN A PREVEDEL MD (NPI 1831185776)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831185776 NPI number — DR. JOHN A PREVEDEL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PREVEDEL
Provider First Name:
JOHN
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
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:
1831185776
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/15/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4900 S MONACO ST
Provider Second Line Business Mailing Address:
#210
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80237-3486
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-750-0822
Provider Business Mailing Address Fax Number:
303-750-1298

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1444 S POTOMAC STREET
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
AURORA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80012-4510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-750-0822
Provider Business Practice Location Address Fax Number:
303-750-1298
Provider Enumeration Date:
09/26/2005

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: 207RC0000X , with the licence number:  24985 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RI0011X , with the licence number: 24985 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 01909223 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01249853 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10026280700 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100174090D , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10026280600 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10026280800 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10026283100 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10026281000 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10026281200 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1982948089 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 109800400 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".




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