1033163266 NPI number — JEFFREY W THORNTON M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033163266 NPI number — JEFFREY W THORNTON M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

THORNTON

Provider First Name:

JEFFREY

Provider Middle Name:

W

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

M

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:

1033163266

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

03/04/2025

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

1906 BLAKE AVE

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

GLENWOOD SPRINGS

Provider Business Mailing Address State Name:

CO

Provider Business Mailing Address Postal Code:

81601-4227

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

970-945-6535

Provider Business Mailing Address Fax Number:

970-945-5460

Provider First Line Business Practice Location Address:

1830 BLAKE AVE STE 101

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

GLENWOOD SPRINGS

Provider Business Practice Location Address State Name:

CO

Provider Business Practice Location Address Postal Code:

81601-4215

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

970-384-7144

Provider Business Practice Location Address Fax Number:

970-384-8115

Provider Enumeration Date:

05/20/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 2084N0400X , with the licence number:  23662 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2084N0400X , with the licence number: 36617 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2084N0400X , with the licence number: 2008003316 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 10025242300 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
• Identifier: 1033163266 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
• Identifier: 1718106 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
• Identifier: 2718106 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
• Identifier: 9000185327 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
• Identifier: 0718106 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
• Identifier: P00325033 . This is a "RR MEDICARE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
• Identifier: 13804 . This is a "WELLMARK - SHENANDOAH" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
• Identifier: 250469 . This is a "MIDLANDS CHOICE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
• Identifier: 95878 . This is a "WELLMARK - 4242 FARNAM" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".