1952360380 NPI number — PAMELA J DEBERGHES MD

Table of content: PAMELA J DEBERGHES MD (NPI 1952360380)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952360380 NPI number — PAMELA J DEBERGHES MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEBERGHES
Provider First Name:
PAMELA
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1952360380
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/17/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1675 GARDEN OF THE GODS RD
Provider Second Line Business Mailing Address:
SUITE 1053 EPC EMPLOYEE HEALTH CENTER
Provider Business Mailing Address City Name:
COLORADO SPRINGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80907-9444
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-520-7600
Provider Business Mailing Address Fax Number:
719-520-7610

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5850 CHAMPIONSHIP VW STE D
Provider Second Line Business Practice Location Address:
EL PASO COUNTY EMPLOYEE HEALTH CENTER
Provider Business Practice Location Address City Name:
COLORADO SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80922-2506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-520-7600
Provider Business Practice Location Address Fax Number:
719-520-7610
Provider Enumeration Date:
03/23/2006

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: 207Q00000X , with the licence number:  36309 , 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: 129535 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2140388 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 440546366 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1868943 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".