1023625662 NPI number — SIGNIFY HEALTH MEDICAL ASSOCIATES OF COLORADO, PLLC.

Table of content: TIMOTHY CHAMBERLAIN PT,MHSC, MTC (NPI 1235153925)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023625662 NPI number — SIGNIFY HEALTH MEDICAL ASSOCIATES OF COLORADO, PLLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SIGNIFY HEALTH MEDICAL ASSOCIATES OF COLORADO, PLLC.
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:
1023625662
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4055 VALLEY VIEW LN STE 400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75244-5071
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-868-5351
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7900 E UNION AVE STE 1100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80237-2746
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-868-5351
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/28/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BRANCH
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
KENNETH
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
866-477-1169

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 20201684431 . This is a "COLORADO SECRETARY OF STATE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".