1326342940 NPI number — SET OF COLORADO SPRINGS

Table of content: (NPI 1326342940)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326342940 NPI number — SET OF COLORADO SPRINGS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SET OF COLORADO SPRINGS
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:
1326342940
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/06/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8140 S HOLLY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CENTENNIAL
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-269-7001
Provider Business Mailing Address Fax Number:
303-764-6640

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2864 S CIRCLE DR
Provider Second Line Business Practice Location Address:
STE 450
Provider Business Practice Location Address City Name:
COLORADO SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-776-8850
Provider Business Practice Location Address Fax Number:
719-776-8855
Provider Enumeration Date:
12/23/2010

Additional Information

Authorized Official

Authorized Official Last Name:
PATTEN
Authorized Official First Name:
CARL
Authorized Official Middle Name:
W.
Authorized Official Title or Position:
DIRECTOR, COMMUNITY BENEFIT
Authorized Official Telephone Number:
303-673-7305

Provider Taxonomy Codes

  • Taxonomy code: 261QC1500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 98084062 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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