1497824288 NPI number — PLATEAU VALLEY SKCHOOL DISTRICT 50

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 1497824288 NPI number — PLATEAU VALLEY SKCHOOL DISTRICT 50

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PLATEAU VALLEY SKCHOOL DISTRICT 50
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:
1497824288
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
56600 HIGHWAY 330
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLLBRAN
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81624-9505
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-487-3547
Provider Business Mailing Address Fax Number:
970-245-0825

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
56600 HIGHWAY 330
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLLBRAN
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81624-9505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-487-3547
Provider Business Practice Location Address Fax Number:
970-245-0825
Provider Enumeration Date:
11/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WICKER
Authorized Official First Name:
JUDITH
Authorized Official Middle Name:
D
Authorized Official Title or Position:
MEDICAID COORDINATOR
Authorized Official Telephone Number:
970-254-5308

Provider Taxonomy Codes

  • Taxonomy code: 251300000X , 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: UN99280540 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com