1396374351 NPI number — VASCULAR LABS OF THE ROCKIES PLLC

Table of content: (NPI 1396374351)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396374351 NPI number — VASCULAR LABS OF THE ROCKIES PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VASCULAR LABS OF THE ROCKIES PLLC
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:
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:
1396374351
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/18/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4105 E FLORIDA AVE STE 100
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:
80222-3636
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-529-5252
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4105 E FLORIDA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80222-3620
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-539-0736
Provider Business Practice Location Address Fax Number:
303-539-0737
Provider Enumeration Date:
04/02/2020

Additional Information

Authorized Official

Authorized Official Last Name:
DINKEL
Authorized Official First Name:
KAMI
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
303-529-5252

Provider Taxonomy Codes

  • Taxonomy code: 305S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1306936885 . This is a "NPPES" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 1952344301 . This is a "NPPES" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 1235454497 . This is a "NPPES" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 1912984386 . This is a "NPPES" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 1942290721 . This is a "NPPES" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 1033116272 . This is a "NPPES" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 1235218942 . This is a "NPPES" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 1093792590 . This is a "NPPES" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 1740222322 . This is a "NPPES" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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