1568450542 NPI number — HARRY H PAYTON D.O

Table of content: HARRY H PAYTON D.O (NPI 1568450542)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568450542 NPI number — HARRY H PAYTON D.O

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PAYTON
Provider First Name:
HARRY
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O
Provider Gender Code:
M

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:
1568450542
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/22/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
920 RUSH DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALIDA
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81201-9669
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-539-9300
Provider Business Mailing Address Fax Number:
719-539-9333

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
920 RUSH DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALIDA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81201-9669
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-539-9300
Provider Business Practice Location Address Fax Number:
719-539-9333
Provider Enumeration Date:
10/12/2005

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: 207YX0905X , with the licence number:  DR.0048772 , 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: E16975 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: AX5099 . This is a "MEDICARE PTAN GRP 152556" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: HX1692 . This is a "MEDICARE PTAN GRP MM8648" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 002298 . This is a "ANTHEM" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 1044199 . This is a "AETNA" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".




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