1558397281 NPI number — HIGH PLAINS TOTAL CARE LLC

Table of content: (NPI 1558397281)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558397281 NPI number — HIGH PLAINS TOTAL CARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HIGH PLAINS TOTAL CARE LLC
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:
ROBERT VAUGHAN CIPPERLY MD
Provider Other Organization Name Type Code:
3
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:
1558397281
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:
1925 E ORMAN AVE
Provider Second Line Business Mailing Address:
STE A 235
Provider Business Mailing Address City Name:
PUEBLO
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81004-3537
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1925 E ORMAN AVE
Provider Second Line Business Practice Location Address:
STE A 235
Provider Business Practice Location Address City Name:
PUEBLO
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81004-3537
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-565-0200
Provider Business Practice Location Address Fax Number:
719-565-0999
Provider Enumeration Date:
06/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CIPPERLY
Authorized Official First Name:
VAUGHAN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
719-565-0200

Provider Taxonomy Codes

  • Taxonomy code: 332900000X , with the licence number:  38639 , 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: 44824785 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0619823 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".




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