1003977828 NPI number — LLOYD B LIFTON MD PC

Table of content: MEGHAN BROOKE GLASCOCK CRNA (NPI 1336506773)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003977828 NPI number — LLOYD B LIFTON MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LLOYD B LIFTON 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:
1003977828
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/11/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 15000
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DURANGO
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81302-8901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-259-2525
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
575 RIVERGATE UNIT 207
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DURANGO
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81301-7490
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-259-0701
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LIFTON
Authorized Official First Name:
LLOYD
Authorized Official Middle Name:
B
Authorized Official Title or Position:
OWNER PRESIDENT
Authorized Official Telephone Number:
970-259-0701

Provider Taxonomy Codes

  • Taxonomy code: 207VG0400X , 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: 04007621 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: U6177 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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