1588724371 NPI number — JG BENEDICT, PHD & ASSOCIATES, P.C.

Table of content: (NPI 1588724371)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588724371 NPI number — JG BENEDICT, PHD & ASSOCIATES, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JG BENEDICT, PHD & ASSOCIATES, P.C.
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:
1588724371
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/26/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7555 E. HAMPDEN AVE
Provider Second Line Business Mailing Address:
#535
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80231-4836
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-358-1455
Provider Business Mailing Address Fax Number:
720-535-1934

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22485 SUNSET CR.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GOLDEN
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-466-3509
Provider Business Practice Location Address Fax Number:
303-753-6498
Provider Enumeration Date:
12/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BENEDICT, PHD
Authorized Official First Name:
J
Authorized Official Middle Name:
G.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
720-466-3509

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  177 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103TC0700X , with the licence number: 177 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 95346 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 07025281 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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