1669457156 NPI number — PULMONARY CONSULTANTS OF COLARADO PC

Table of content: ANNE BEAUFORT M.A., LPC (NPI 1184178980)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669457156 NPI number — PULMONARY CONSULTANTS OF COLARADO PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PULMONARY CONSULTANTS OF COLARADO PC
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:
JULIE SUTARIK MD PC
Provider Other Organization Name Type Code:
4
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:
1669457156
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1601 E 19TH AVE
Provider Second Line Business Mailing Address:
STE 6250
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80218-1291
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-860-7530
Provider Business Mailing Address Fax Number:
303-860-1057

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1601 E 19TH AVE
Provider Second Line Business Practice Location Address:
STE 6250
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80218-1291
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-860-7530
Provider Business Practice Location Address Fax Number:
303-860-1057
Provider Enumeration Date:
12/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SUTARIK
Authorized Official First Name:
JULIANNA
Authorized Official Middle Name:
MARIA
Authorized Official Title or Position:
PRESIDENT OWNER
Authorized Official Telephone Number:
303-860-7530

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X , 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: 74580787 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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