1447325097 NPI number — FRONT RANGE PSYCHIATRIC ASSOCIATES, P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447325097 NPI number — FRONT RANGE PSYCHIATRIC ASSOCIATES, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FRONT RANGE PSYCHIATRIC ASSOCIATES, P.C.
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:
1447325097
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/27/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
56 CLUB MANOR DR
Provider Second Line Business Mailing Address:
100
Provider Business Mailing Address City Name:
PUEBLO
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81008-1679
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-584-4767
Provider Business Mailing Address Fax Number:
719-584-4808

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
56 CLUB MANOR DR
Provider Second Line Business Practice Location Address:
100
Provider Business Practice Location Address City Name:
PUEBLO
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81008-1679
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-584-4767
Provider Business Practice Location Address Fax Number:
719-584-4808
Provider Enumeration Date:
11/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MARTIN
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
DANA
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
719-584-4767

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , 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: 56826338 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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