1376682740 NPI number — BRECKENRIDGE MEDICAL CLINIC, LLC

Table of content: DR. CHRISTINE EMILIE GHATAN MD (NPI 1447591854)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376682740 NPI number — BRECKENRIDGE MEDICAL CLINIC, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRECKENRIDGE MEDICAL CLINIC, LLC
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:
1376682740
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/20/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
DEPARTMENT 1965
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80291-1965
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-486-5500
Provider Business Mailing Address Fax Number:
303-486-5501

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
555 SOUTH PARK AVENUE
Provider Second Line Business Practice Location Address:
PLAZA 2
Provider Business Practice Location Address City Name:
BRECKENRIDGE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-453-1010
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CHODOWSKI
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
970-668-2852

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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