1134131733 NPI number — DR. KEVIN P O'BRIEN M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134131733 NPI number — DR. KEVIN P O'BRIEN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
O'BRIEN
Provider First Name:
KEVIN
Provider Middle Name:
P
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1134131733
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6801 S YOSEMITE ST STE 180
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CENTENNIAL
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80112-1411
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-773-9000
Provider Business Mailing Address Fax Number:
303-770-1449

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3260 E 104TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
THORNTON
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80233-4406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-929-8300
Provider Business Practice Location Address Fax Number:
720-929-8444
Provider Enumeration Date:
08/12/2006

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: 207RA0201X , with the licence number:  42142 , 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: 0873194 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 62777076 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 26003329908 . This is a "PACIFICARE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 1057406 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: OBO68158 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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