1629199062 NPI number — CHRMEG MED INC

Table of content: (NPI 1629199062)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629199062 NPI number — CHRMEG MED INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHRMEG MED INC
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:
PARKER FAMILY CARE
Provider Other Organization Name Type Code:
3
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:
1629199062
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10259 S. PARKER ROAD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
PARKER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80134
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-805-2273
Provider Business Mailing Address Fax Number:
303-805-2287

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10259 S. PARKER ROAD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
PARKER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-805-2273
Provider Business Practice Location Address Fax Number:
303-805-2287
Provider Enumeration Date:
04/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WEST
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRACTICE OWNER/PHYSICIAN
Authorized Official Telephone Number:
303-805-2273

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  40652 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363AM0700X , with the licence number: 1179 , 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: 40652 . This is a "PHYSICIAN STATE LICENSE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 1790838266 . This is a "NPI FOR MIDLEVEL PROVIDER" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 1179 . This is a "LICENSE FOR MIDLEVEL PROV" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 126549112 . This is a "PHYSICIAN NPI" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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