1386658144 NPI number — DR. KIMBERLY PAULINE VANSCRIVER M.D.

Table of content: DR. KIMBERLY PAULINE VANSCRIVER M.D. (NPI 1386658144)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386658144 NPI number — DR. KIMBERLY PAULINE VANSCRIVER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VANSCRIVER
Provider First Name:
KIMBERLY
Provider Middle Name:
PAULINE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VAN SCRIVER
Provider Other First Name:
KIMBERLY
Provider Other Middle Name:
PAULINE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1386658144
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1805 SHEA CENTER DR STE 450
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIGHLANDS RANCH
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80129-2255
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-738-1100
Provider Business Mailing Address Fax Number:
303-738-1310

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7780 S BROADWAY
Provider Second Line Business Practice Location Address:
SUITE 280
Provider Business Practice Location Address City Name:
LITTLETON
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-738-1100
Provider Business Practice Location Address Fax Number:
303-738-1310
Provider Enumeration Date:
07/28/2006

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: 207V00000X , with the licence number:  DR.00051657 , 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)