1891158952 NPI number — PODIATRY ASSOCIATES, INC

Table of content: (NPI 1891158952)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891158952 NPI number — PODIATRY ASSOCIATES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PODIATRY ASSOCIATES, INC
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:
PODIATRY ASSOCIATES AT CHERRY CREEK
Provider Other Organization Name Type Code:
3
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:
1891158952
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/02/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7505 VILLAGE SQUARE DR
Provider Second Line Business Mailing Address:
# 101
Provider Business Mailing Address City Name:
CASTLE PINES
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80108-3692
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-805-5156
Provider Business Mailing Address Fax Number:
303-805-5157

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 S JACKSON ST STE 310
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80209-3134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-805-5156
Provider Business Practice Location Address Fax Number:
303-805-5157
Provider Enumeration Date:
04/05/2016

Additional Information

Authorized Official

Authorized Official Last Name:
CLASSEN
Authorized Official First Name:
CYNTHIA
Authorized Official Middle Name:
Authorized Official Title or Position:
DOCTOR/OWNER
Authorized Official Telephone Number:
303-805-5156

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 41272358 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com