1558276519 NPI number — NICHOLAS RYAN UMHOLTZ

Table of content: NICHOLAS RYAN UMHOLTZ (NPI 1558276519)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558276519 NPI number — NICHOLAS RYAN UMHOLTZ

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
UMHOLTZ
Provider First Name:
NICHOLAS
Provider Middle Name:
RYAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
UMHOLTZ
Provider Other First Name:
NICK
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1558276519
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/15/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4038 W 15TH STREET LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREELEY
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80634-2761
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-371-9836
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6767 29TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREELEY
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80634-5474
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-652-2000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/15/2026

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: 163WC0200X , with the licence number:  RN.1672757 , 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)