1972771830 NPI number — MISGELOW ENTERPRISES LLC

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 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)