1568616951 NPI number — NORTH VISTA MEDICAL PARTNERS LLC

Table of content: (NPI 1568616951)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568616951 NPI number — NORTH VISTA MEDICAL PARTNERS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH VISTA MEDICAL PARTNERS 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:
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:
1568616951
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4943 STATE HWY 52
Provider Second Line Business Mailing Address:
STE. 240
Provider Business Mailing Address City Name:
DACONO
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80514
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-501-2600
Provider Business Mailing Address Fax Number:
877-764-4622

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4943 STATE HIGHWAY 52 STE 240
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DACONO
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80514-9107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-501-2600
Provider Business Practice Location Address Fax Number:
877-764-4622
Provider Enumeration Date:
11/11/2008

Additional Information

Authorized Official

Authorized Official Last Name:
FLANAGAN
Authorized Official First Name:
CLINT
Authorized Official Middle Name:
R
Authorized Official Title or Position:
MD/CEO
Authorized Official Telephone Number:
303-501-2600

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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