1174580914 NPI number — GEORGE BIRKS MD PLLC

Table of content: (NPI 1174580914)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174580914 NPI number — GEORGE BIRKS MD PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GEORGE BIRKS MD PLLC
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:
1174580914
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/02/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8537
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PUEBLO
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81008-8537
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-566-1869
Provider Business Mailing Address Fax Number:
719-565-1901

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1930 E ORMAN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PUEBLO
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81004-3553
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-565-1900
Provider Business Practice Location Address Fax Number:
719-565-1901
Provider Enumeration Date:
04/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BIRKS
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
F
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
719-565-1900

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  35413 , 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: 82685029 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110246700 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: DG5436 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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