1316135064 NPI number — DENNIS L BALLINGER MA

Table of content: DENNIS L BALLINGER MA (NPI 1316135064)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316135064 NPI number — DENNIS L BALLINGER MA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BALLINGER
Provider First Name:
DENNIS
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA
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:
1316135064
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
155 INVERNESS DR W
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
ENGLEWOOD
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80112-5095
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-779-9676
Provider Business Mailing Address Fax Number:
303-889-4800

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
155 INVERNESS DR W
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
ENGLEWOOD
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80112-5095
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-779-9676
Provider Business Practice Location Address Fax Number:
303-889-4800
Provider Enumeration Date:
10/09/2007

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: 106H00000X , with the licence number:  MFT0001105 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YA0400X , with the licence number: ACC 0020817 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 05056 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9002BA . This is a "REGENCE" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com