1679565758 NPI number — DANN CONRAD BYCK III MD

Table of content: DANN CONRAD BYCK III MD (NPI 1679565758)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679565758 NPI number — DANN CONRAD BYCK III MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BYCK
Provider First Name:
DANN
Provider Middle Name:
CONRAD
Provider Name Prefix Text:
Provider Name Suffix Text:
III
Provider Credential Text:
MD
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:
1679565758
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/18/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4105 BRIARGATE PKWY STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLORADO SPRINGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80920-3487
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-402-0200
Provider Business Mailing Address Fax Number:
719-352-0121

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4105 BRIARGATE PKWY STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLORADO SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80920-3487
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-420-0200
Provider Business Practice Location Address Fax Number:
719-352-0121
Provider Enumeration Date:
08/16/2005

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: 207X00000X , with the licence number:  51866291205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XX0005X , with the licence number: CDR.0002201 , 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: 4360680001 . This is a "CIGNA DMERC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 870580455 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 870680455 . This is a "AM POSTAL WORKERS UNION" identifier . This identifiers is of the category "OTHER".
  • Identifier: 870680455 . This is a "CBSA CORPORATE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 870680455 . This is a "CCN" identifier . This identifiers is of the category "OTHER".
  • Identifier: D4621 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 51866291200001 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 870680455 . This is a "BENEFIT PLAN ADMIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 51866291200001 . This is a "BCBS OF OTHER STATE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 870680455BYC . This is a "ED IHC CARE PLUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: OM0000058953 . This is a "ALTUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 51866291200001 . This is a "BC OF WYO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 659750 . This is a "DESERT MUTUAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 870680455 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 870680455 . This is a "EBMS EMPLOYEE BENEFIT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 870680455 . This is a "BENEFIT PLANNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 870680455 . This is a "I159 ACORDIA NATIONAL" identifier . This identifiers is of the category "OTHER".




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