1619953890 NPI number — DR. RICHARD J BELLON M.D.

Table of content: DR. RICHARD J BELLON M.D. (NPI 1619953890)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619953890 NPI number — DR. RICHARD J BELLON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BELLON
Provider First Name:
RICHARD
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1619953890
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/09/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10800 E GEDDES AVE STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ENGLEWOOD
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80112-3895
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-761-9190
Provider Business Mailing Address Fax Number:
720-874-4462

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
499 E HAMPDEN AVE
Provider Second Line Business Practice Location Address:
SUITE 380
Provider Business Practice Location Address City Name:
ENGLEWOOD
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-493-3345
Provider Business Practice Location Address Fax Number:
720-874-4437
Provider Enumeration Date:
12/19/2005

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: 2085R0202X , with the licence number:  MD17585 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 04-36349 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 25087 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 43552 , 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: 1619953890 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 84-059792913 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200424520A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 07724012 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1619953890 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 62983521 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00759816 . This is a "RR MCR RIN" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 1679513196 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10025709000 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 175381 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200418270A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 121624400 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00247190 . This is a "RR MEIDCARE RIA" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: P00307174 . This is a "RR MEDICARE MIC" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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