1033186846 NPI number — DR. JEFFREY M SIPPEL M.D.

Table of content: DR. JEFFREY M SIPPEL M.D. (NPI 1033186846)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033186846 NPI number — DR. JEFFREY M SIPPEL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIPPEL
Provider First Name:
JEFFREY
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1033186846
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 110429
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AURORA
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80042-0429
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1635 AURORA CT
Provider Second Line Business Practice Location Address:
#F747
Provider Business Practice Location Address City Name:
AURORA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80045-2541
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-848-4400
Provider Business Practice Location Address Fax Number:
720-848-0750
Provider Enumeration Date:
03/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X , with the licence number:  30877 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 30877 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0200X , with the licence number: 30877 , 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: 200389180A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: Z3317 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200088580A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01308774 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 04594040 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 62380044 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8464612 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 122161200 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".




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