1972927382 NPI number — FROC, PC

Table of content: MAHA L BOUAICHI SPT (NPI 1780922815)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972927382 NPI number — FROC, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FROC, PC
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:
FRONT RANGE ORTHOPEDICS & SPINE
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:
1972927382
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1610 DRY CREEK DR STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONGMONT
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80503-6405
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-772-1600
Provider Business Mailing Address Fax Number:
303-772-9317

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 EXEMPLA CIR
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-890-8292
Provider Business Practice Location Address Fax Number:
303-772-9317
Provider Enumeration Date:
02/06/2014

Additional Information

Authorized Official

Authorized Official Last Name:
PATER
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
303-772-1600

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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