1568177392 NPI number — CARLYLE CARDIOVASCULAR CONSULTANTS PLLC

Table of content: (NPI 1568177392)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568177392 NPI number — CARLYLE CARDIOVASCULAR CONSULTANTS PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARLYLE CARDIOVASCULAR CONSULTANTS PLLC
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:
1568177392
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5318 5TH ST UNIT A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOULDER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80304-4818
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
720-388-7760
Provider Business Mailing Address Fax Number:
720-405-4228

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1434 SPRUCE ST STE 110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOULDER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80302-4815
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-388-7760
Provider Business Practice Location Address Fax Number:
720-405-4228
Provider Enumeration Date:
01/17/2023

Additional Information

Authorized Official

Authorized Official Last Name:
CARLYLE
Authorized Official First Name:
LYNN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
720-388-7760

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com