1841325222 NPI number — AURORA FAMILY PRACTICE GROUP PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841325222 NPI number — AURORA FAMILY PRACTICE GROUP PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AURORA FAMILY PRACTICE GROUP 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:
1841325222
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/10/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1550 S POTOMAC ST
Provider Second Line Business Mailing Address:
SUITE 370
Provider Business Mailing Address City Name:
AURORA
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80012-5455
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-369-1080
Provider Business Mailing Address Fax Number:
303-750-4913

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1550 S POTOMAC ST
Provider Second Line Business Practice Location Address:
SUITE 370
Provider Business Practice Location Address City Name:
AURORA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80012-5455
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-369-1080
Provider Business Practice Location Address Fax Number:
303-750-4913
Provider Enumeration Date:
02/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ANDERSON
Authorized Official First Name:
DEBORAH
Authorized Official Middle Name:
KATHLEEN
Authorized Official Title or Position:
BILLING SUPERVISOR
Authorized Official Telephone Number:
303-369-1080

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  11245 , 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: AU71504 . This is a "ANTHEM BL CROSS BL SHIELD" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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