1861613028 NPI number — MR. MARK DARREN SEEVERS CSA

Table of content: MR. MARK DARREN SEEVERS CSA (NPI 1861613028)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861613028 NPI number — MR. MARK DARREN SEEVERS CSA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEEVERS
Provider First Name:
MARK
Provider Middle Name:
DARREN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
CSA
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:
1861613028
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/01/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10244 ALAXA LANE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIGHLANDS RANCH
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80110-8028
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
720-327-1335
Provider Business Mailing Address Fax Number:
303-395-0826

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10239 BENTWOOD CIRCLE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HIGHLANDS RANCH
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80126-0239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-791-8565
Provider Business Practice Location Address Fax Number:
303-395-0826
Provider Enumeration Date:
05/02/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
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Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 246ZC0007X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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