1144238569 NPI number — CYNTHIA S CLASSEN DPM

Table of content: MATTHEW BARTZ (NPI 1164078895)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144238569 NPI number — CYNTHIA S CLASSEN DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CLASSEN
Provider First Name:
CYNTHIA
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OBERHOLTZER
Provider Other First Name:
CYNTHIA
Provider Other Middle Name:
S
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPM
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1144238569
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/02/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7505 VILLAGE SQUARE DR
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
CASTLE PINES
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80108-3692
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-805-5156
Provider Business Mailing Address Fax Number:
303-805-5157

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7505 VILLAGE SQUARE DR
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
CASTLE PINES
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80108-3692
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-805-5156
Provider Business Practice Location Address Fax Number:
303-805-5157
Provider Enumeration Date:
08/03/2006

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: 213ES0103X , with the licence number:  490 , 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: 480033568 . This is a "RRW MEDICARE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: OB51983 . This is a "HMO COLORADO" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 2700336 . This is a "EVERCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: OB51983 . This is a "BCBS" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 84153666401 . This is a "PACIFICARE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 01004902 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3893610001 . This is a "PALMETTO" identifier . This identifiers is of the category "OTHER".




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