1154860112 NPI number — RITA A MELLAND R.T.(R)(M)(CT) (ARRT

Table of content: RITA A MELLAND R.T.(R)(M)(CT) (ARRT (NPI 1154860112)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154860112 NPI number — RITA A MELLAND R.T.(R)(M)(CT) (ARRT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MELLAND
Provider First Name:
RITA
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
R.T.(R)(M)(CT) (ARRT
Provider Gender Code:
F

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:
1154860112
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/22/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1625 MEDICAL CENTER PT
Provider Second Line Business Mailing Address:
SUITE 190
Provider Business Mailing Address City Name:
COLORADO SPRINGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80907-8731
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-955-6000
Provider Business Mailing Address Fax Number:
719-955-9595

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1625 MEDICAL CENTER PT
Provider Second Line Business Practice Location Address:
SUITE 190
Provider Business Practice Location Address City Name:
COLORADO SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80907-8731
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-955-6000
Provider Business Practice Location Address Fax Number:
719-955-9595
Provider Enumeration Date:
02/22/2017

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: 2471C3401X , with the licence number:  237735 , 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)





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