1649215864 NPI number — 1200 MADISON SREET INC

Table of content: (NPI 1649215864)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649215864 NPI number — 1200 MADISON SREET INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
1200 MADISON SREET 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:
Provider Other Organization Name Type Code:
6
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:
1649215864
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 MADISON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80206-3440
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-388-3679
Provider Business Mailing Address Fax Number:
303-393-7604

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 MADISON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80206-3440
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-388-3679
Provider Business Practice Location Address Fax Number:
303-393-7604
Provider Enumeration Date:
06/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DHALIWAL
Authorized Official First Name:
JIT
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
303-388-3679

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  PDO30 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 62103571 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0601496 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com