1093819021 NPI number — ANTHONY J CHR ISTOFF D O

Table of content: (NPI 1093819021)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093819021 NPI number — ANTHONY J CHR ISTOFF D O

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANTHONY J CHR ISTOFF D O
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:
ANTHONY J CHRISTOF DO PC
Provider Other Organization Name Type Code:
3
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:
1093819021
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/26/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
715 N CASCADE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLORADO SPGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80903-3289
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-471-9891
Provider Business Mailing Address Fax Number:
719-471-4493

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
715 N CASCADE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLORADO SPGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80903-3289
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-471-9891
Provider Business Practice Location Address Fax Number:
719-471-4493
Provider Enumeration Date:
09/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHRISTOFF
Authorized Official First Name:
ANTHONY
Authorized Official Middle Name:
JAMES
Authorized Official Title or Position:
PRESIDENT PHYSICIAN
Authorized Official Telephone Number:
719-471-9891

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  34580 , 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: 01345800 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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