1265836043 NPI number — AKVC CENTRAL LLC

Table of content: (NPI 1265836043)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265836043 NPI number — AKVC CENTRAL LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AKVC CENTRAL 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:
1265836043
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2221 E BIJOU ST.
Provider Second Line Business Mailing Address:
STE. 100
Provider Business Mailing Address City Name:
COLORADO SPRINGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80909
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-442-0071
Provider Business Mailing Address Fax Number:
719-473-5303

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
883 N ACADEMY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLORADO SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80909-8307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-442-0071
Provider Business Practice Location Address Fax Number:
719-473-5303
Provider Enumeration Date:
10/22/2014

Additional Information

Authorized Official

Authorized Official Last Name:
LEBLANC
Authorized Official First Name:
SAMANTHA
Authorized Official Middle Name:
B
Authorized Official Title or Position:
CREDENTIALING SPECIALIST
Authorized Official Telephone Number:
719-323-2372

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WP0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200871800A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 310087377 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 27952291 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: OP1000412 . This is a "STATE" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 200532530C , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: DA2086 . This is a "STATE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1796 . This is a "STATE" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: OPT.0001462 . This is a "STATE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: OPT732 . This is a "STATE" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 016627801 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 019177299 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 97789054 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3033 . This is a "STATE" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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