1184810491 NPI number — RICHARD O'BRIEN, MD, LLC

Table of content: (NPI 1184810491)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184810491 NPI number — RICHARD O'BRIEN, MD, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RICHARD O'BRIEN, 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:
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:
1184810491
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4500 EAST 9TH AVE #550
Provider Second Line Business Mailing Address:
RICHARD O'BRIEN, MD, LLC
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-329-8998
Provider Business Mailing Address Fax Number:
303-329-9020

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4500 EAST 9TH AVE #550
Provider Second Line Business Practice Location Address:
RICHARD O'BRIEN, MD, LLC
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-329-8998
Provider Business Practice Location Address Fax Number:
303-329-9020
Provider Enumeration Date:
09/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RADICH
Authorized Official First Name:
TAMARA
Authorized Official Middle Name:
V
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
303-423-0758

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  24590 , 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: 24590 . This is a "COLORADO LIC" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 01245901 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com