1184608531 NPI number — THOMAS J PAZIK MD LLC

Table of content: (NPI 1184608531)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184608531 NPI number — THOMAS J PAZIK MD LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THOMAS J PAZIK MD 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:
1184608531
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6801 W 20TH ST
Provider Second Line Business Mailing Address:
STE 201
Provider Business Mailing Address City Name:
GREELEY
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80634-9637
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-330-1090
Provider Business Mailing Address Fax Number:
970-330-2925

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6801 W 20TH ST
Provider Second Line Business Practice Location Address:
STE 201
Provider Business Practice Location Address City Name:
GREELEY
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80634-9637
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-330-1090
Provider Business Practice Location Address Fax Number:
970-330-2925
Provider Enumeration Date:
11/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
PAZIK
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
970-330-1090

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  34081 , 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: DA4434 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 93802820 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: TH664537 . This is a "BCBS" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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