1336139039 NPI number — DR. CHRISTINA M REIMER MD

Table of content: DR. CHRISTINA M REIMER MD (NPI 1336139039)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336139039 NPI number — DR. CHRISTINA M REIMER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REIMER
Provider First Name:
CHRISTINA
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1336139039
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/26/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4674 SNOW MESA DR
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
FORT COLLINS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80528-8615
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-482-3712
Provider Business Mailing Address Fax Number:
970-266-4190

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4674 SNOW MESA DR.
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
FORT COLLINS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-482-3712
Provider Business Practice Location Address Fax Number:
970-482-4057
Provider Enumeration Date:
10/24/2005

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: 207R00000X , with the licence number:  36206 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 46541 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0468272 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 27277224 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 39271 . This is a "WELLMARK BCBS" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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