1104910181 NPI number — JOSEPH M LOPEZ MD PC

Table of content: ASHLEY NICHOLE LONG FNP (NPI 1902470842)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104910181 NPI number — JOSEPH M LOPEZ MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOSEPH M LOPEZ MD 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:
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:
1104910181
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1136 E STUART ST
Provider Second Line Business Mailing Address:
SUITE 4202
Provider Business Mailing Address City Name:
FT COLLINS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80525
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-221-5925
Provider Business Mailing Address Fax Number:
970-221-5012

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1136 E STUART ST
Provider Second Line Business Practice Location Address:
SUITE 4202
Provider Business Practice Location Address City Name:
FT COLLINS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80525
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-221-5925
Provider Business Practice Location Address Fax Number:
970-221-5012
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LOPEZ
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
970-221-5925

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: PR32757550001 . This is a "CIGNA HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 55181 . This is a "FEDERA BC BS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0004586257 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000585011 . This is a "APWU HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01252378 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: C09900002163 . This is a "SIERRA HEALTH & LIFE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010011909 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 120085BF . This is a "PREFERRED ADMINISTRATIVE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 33143 . This is a "ANTHEM BC BS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0135688 . This is a "MAIL HANDLERS BENEFIT PLA" identifier . This identifiers is of the category "OTHER".




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