1972771830 NPI number — MISGELOW ENTERPRISES LLC

Table of content: (NPI 1972771830)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972771830 NPI number — MISGELOW ENTERPRISES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MISGELOW ENTERPRISES LLC
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:
1972771830
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/28/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3955 E EXPOSITION AVE
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80209-5000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-777-5058
Provider Business Mailing Address Fax Number:
303-777-5058

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3955 E EXPOSITION AVE
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80209-5000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-777-5058
Provider Business Practice Location Address Fax Number:
303-777-5058
Provider Enumeration Date:
02/13/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SPENDELOW
Authorized Official First Name:
JUDITH
Authorized Official Middle Name:
H.
Authorized Official Title or Position:
REGISTERED AGENT
Authorized Official Telephone Number:
303-777-5058

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  2467 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103TC0700X , with the licence number: 2467 , 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)