1093104713 NPI number — MS. KIMBERLY THORNTON

Table of content: MS. KIMBERLY THORNTON (NPI 1093104713)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093104713 NPI number — MS. KIMBERLY THORNTON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THORNTON
Provider First Name:
KIMBERLY
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

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:
1093104713
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/19/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6169 S BALSAM WAY
Provider Second Line Business Mailing Address:
SUITE 330
Provider Business Mailing Address City Name:
LITTLETON
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80123-3062
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-933-8230
Provider Business Mailing Address Fax Number:
303-922-1145

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6169 S BALSAM WAY
Provider Second Line Business Practice Location Address:
SUITE 330
Provider Business Practice Location Address City Name:
LITTLETON
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80123-3062
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-933-8230
Provider Business Practice Location Address Fax Number:
303-922-1145
Provider Enumeration Date:
01/19/2015

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: 124Q00000X , with the licence number:  000002987 , 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: 76627772 . This is a "MEDICAID" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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