1275169997 NPI number — WESTERN COLORADO HEARING CLINIC

Table of content: (NPI 1275169997)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275169997 NPI number — WESTERN COLORADO HEARING CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WESTERN COLORADO HEARING CLINIC
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:
1275169997
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/12/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2139 N 12TH ST STE 4
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAND JUNCTION
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81501-2910
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-549-4660
Provider Business Mailing Address Fax Number:
970-549-4658

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2372 G RD STE 270
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAND JUNCTION
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81505-9679
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-549-4660
Provider Business Practice Location Address Fax Number:
970-549-4658
Provider Enumeration Date:
03/13/2020

Additional Information

Authorized Official

Authorized Official Last Name:
BEBEE
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
970-270-4986

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 90017989 . This is a "MEDICAID" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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