1609337906 NPI number — MR. TIMOTHY WAYNE CROY MS, CAC II

Table of content: MR. TIMOTHY WAYNE CROY MS, CAC II (NPI 1609337906)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609337906 NPI number — MR. TIMOTHY WAYNE CROY MS, CAC II

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CROY
Provider First Name:
TIMOTHY
Provider Middle Name:
WAYNE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MS, CAC II
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CASTRO CROY
Provider Other First Name:
TIMOTHY
Provider Other Middle Name:
WAYNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1609337906
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/28/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12487 E AMHERST CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AURORA
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80014-3305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
720-498-5613
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10699 MELODY DR STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTHGLENN
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80234-4131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-252-4179
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/28/2019

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: 101YA0400X , with the licence number:  ACB.0008498 , 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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