1558388264 NPI number — SHARON QUACH DPM PC

Table of content: (NPI 1558388264)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558388264 NPI number — SHARON QUACH DPM PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHARON QUACH DPM PC
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:
6
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:
1558388264
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12201 PECOS ST
Provider Second Line Business Mailing Address:
SUITE # 400
Provider Business Mailing Address City Name:
WESTMINSTER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80234-3888
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-469-9292
Provider Business Mailing Address Fax Number:
303-438-8951

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12201 PECOS ST
Provider Second Line Business Practice Location Address:
SUITE # 400
Provider Business Practice Location Address City Name:
WESTMINSTER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80234-3888
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-469-9292
Provider Business Practice Location Address Fax Number:
303-438-8951
Provider Enumeration Date:
07/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
QUACH
Authorized Official First Name:
SHARON
Authorized Official Middle Name:
TRAN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
303-469-9292

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  651 , 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: 1558388264 . This is a "NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 653789001 . This is a "DME" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: C0A107154 . This is a "MEMORIAL PIN" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: P00636035 . This is a "MEDICARE RR" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 1801844519 . This is a "TRICARE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 80405762 . This is a "MEDICAID ID" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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