1225026362 NPI number — ROBERT MCGRATH MD

Table of content: ROBERT MCGRATH MD (NPI 1225026362)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225026362 NPI number — ROBERT MCGRATH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCGRATH
Provider First Name:
ROBERT
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1225026362
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1810 E 3RD AVE
Provider Second Line Business Mailing Address:
STE 101
Provider Business Mailing Address City Name:
DURANGO
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81301-5025
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-247-4567
Provider Business Mailing Address Fax Number:
970-533-7310

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1810 E 3RD AVE
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
DURANGO
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81301-5025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-247-4567
Provider Business Practice Location Address Fax Number:
970-533-7310
Provider Enumeration Date:
10/12/2005

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: 208000000X , with the licence number:  18835 , 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: 84070694583 . This is a "PACIFICARE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: MCR17483 . This is a "ANTHEM BCBS" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 201006576 . This is a "PRESBYTERIAN HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: T0658 . This is a "MEDICAID OF UTAH" identifier . This identifiers is of the category "OTHER".
  • Identifier: Y4632 . This is a "NEW MEXICO MEDICAID" identifier . This identifiers is of the category "OTHER".
  • Identifier: NM00998 . This is a "BCBS OF NEW MEXICO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 370018626 . This is a "TRAVELERS MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01188358 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 84070694587 . This is a "ROCKY MOUNTAIN HEALTH PLA" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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