1578583969 NPI number — TOTAL HEALTHCARE DBA CENTURA CENTERS FOR OCCUPATIONAL MEDICINE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578583969 NPI number — TOTAL HEALTHCARE DBA CENTURA CENTERS FOR OCCUPATIONAL MEDICINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOTAL HEALTHCARE DBA CENTURA CENTERS FOR OCCUPATIONAL MEDICINE
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:
1578583969
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3030 N CIRCLE DR
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
COLORADO SPRINGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80909-1177
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-475-9496
Provider Business Mailing Address Fax Number:
719-471-4448

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3030 N CIRCLE DR
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
COLORADO SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80909-1177
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-475-9496
Provider Business Practice Location Address Fax Number:
719-471-4448
Provider Enumeration Date:
07/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JARDON
Authorized Official First Name:
SUE
Authorized Official Middle Name:
C
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
719-475-9496

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  84092732 , 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)





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