1093274409 NPI number — NORTHERN COLORADO COMMUNITY URGENT CARE, PC

Table of content: (NPI 1093274409)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093274409 NPI number — NORTHERN COLORADO COMMUNITY URGENT CARE, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHERN COLORADO COMMUNITY URGENT CARE, PC
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:
6
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:
1093274409
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1159 EAGLE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOVELAND
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80537-8020
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-219-5223
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1275 EAGLE DR STE 1159
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOVELAND
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80537-8058
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-760-7944
Provider Business Practice Location Address Fax Number:
970-672-2884
Provider Enumeration Date:
03/15/2019

Additional Information

Authorized Official

Authorized Official Last Name:
BECK
Authorized Official First Name:
BRYAN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
815-713-2600

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com