1306339163 NPI number — COLORADO URGENT CARE PHYSICIANS, PC

Table of content: GERALYN MARIE MORRIS MACCCA (NPI 1578742557)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306339163 NPI number — COLORADO URGENT CARE PHYSICIANS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLORADO URGENT CARE PHYSICIANS, PC
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:
1306339163
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/29/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
901 W HAMPDEN AVE UNIT 103
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ENGLEWOOD
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80110-7330
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-761-1699
Provider Business Mailing Address Fax Number:
303-761-1475

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5102 SOUTH BROADWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ENGLEWOOD
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-761-1699
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/07/2018

Additional Information

Authorized Official

Authorized Official Last Name:
GORDON
Authorized Official First Name:
IRIT
Authorized Official Middle Name:
W
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
303-761-1699

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 31180566 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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