1184005308 NPI number — HEALTHFIT MEDICAL PROFESSIONALS, LLC

Table of content: (NPI 1184005308)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184005308 NPI number — HEALTHFIT MEDICAL PROFESSIONALS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTHFIT MEDICAL PROFESSIONALS, LLC
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:
1184005308
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/07/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2356 MEADOWS BLVD
Provider Second Line Business Mailing Address:
SUITE 140B
Provider Business Mailing Address City Name:
CASTLE ROCK
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80109-8405
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-218-7774
Provider Business Mailing Address Fax Number:
303-660-5065

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2356 MEADOWS BLVD
Provider Second Line Business Practice Location Address:
SUITE 140B
Provider Business Practice Location Address City Name:
CASTLE ROCK
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80109-8405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-218-7774
Provider Business Practice Location Address Fax Number:
303-660-5065
Provider Enumeration Date:
06/12/2015

Additional Information

Authorized Official

Authorized Official Last Name:
PEREZ
Authorized Official First Name:
MARLOW
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
303-886-4440

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: DW0266 . This is a "MEDICARE RR" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 76609774 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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