1033199070 NPI number — DR. TIM CARLSEN D.P.M.

Table of content: DR. TIM CARLSEN D.P.M. (NPI 1033199070)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033199070 NPI number — DR. TIM CARLSEN D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARLSEN
Provider First Name:
TIM
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.P.M.
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:
1033199070
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2620 TENDERFOOT HILL ST
Provider Second Line Business Mailing Address:
SUITE 10
Provider Business Mailing Address City Name:
COLORADO SPRINGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80906-3981
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-576-2080
Provider Business Mailing Address Fax Number:
719-576-2248

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2620 TENDERFOOT HILL ST
Provider Second Line Business Practice Location Address:
SUITE 10
Provider Business Practice Location Address City Name:
COLORADO SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80906-3981
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-576-2080
Provider Business Practice Location Address Fax Number:
719-576-2248
Provider Enumeration Date:
01/17/2006

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: 213EP1101X , with the licence number:  642 , 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: 12451576 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00147284 . This is a "RRW MEDICARE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 841469291005 . This is a "RMHMO" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 84146929104 . This is a "PACIFICARE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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