1124058920 NPI number — ID CONSULTANTS INC

Table of content: (NPI 1124058920)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124058920 NPI number — ID CONSULTANTS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ID CONSULTANTS INC
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:
1124058920
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1726 COLE BLVD STE 250
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKEWOOD
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80401-3262
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
855-478-1528
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3401 ENTERPRISE PKWY STE 110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEACHWOOD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44122-7340
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-448-1060
Provider Business Practice Location Address Fax Number:
216-450-1031
Provider Enumeration Date:
07/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROTTURA
Authorized Official First Name:
SUE
Authorized Official Middle Name:
ELLEN
Authorized Official Title or Position:
CHIEF OPERATING OFFICER
Authorized Official Telephone Number:
561-323-8987

Provider Taxonomy Codes

  • Taxonomy code: 207RI0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QI0500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2519297 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0119080 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2624262 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2519288 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2485074 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2519279 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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