1982660817 NPI number — LAURA K. POMERENKE, MD, PC

Table of content: (NPI 1982660817)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982660817 NPI number — LAURA K. POMERENKE, MD, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAURA K. POMERENKE, MD, 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:
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:
1982660817
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3030 N CIRCLE DR
Provider Second Line Business Mailing Address:
SUITE 216
Provider Business Mailing Address City Name:
COLORADO SPRINGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80909-1177
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-471-3930
Provider Business Mailing Address Fax Number:
719-471-3543

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3030 N CIRCLE DR
Provider Second Line Business Practice Location Address:
SUITE 216
Provider Business Practice Location Address City Name:
COLORADO SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80909-1177
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-471-3930
Provider Business Practice Location Address Fax Number:
719-471-3543
Provider Enumeration Date:
04/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
POMERENKE
Authorized Official First Name:
LAURA
Authorized Official Middle Name:
KAY
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
719-471-3930

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  34528 , 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: 65156340 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 38270 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com