1730118795 NPI number — SAFEWAY INC

Table of content: (NPI 1730118795)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730118795 NPI number — SAFEWAY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAFEWAY 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:
1730118795
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/12/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5918 STONERIDGE MALL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLEASANTON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94588-3229
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-467-2811
Provider Business Mailing Address Fax Number:
925-467-2802

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7150 LEETSDALE DR
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:
80224-3529
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-377-7116
Provider Business Practice Location Address Fax Number:
303-355-4177
Provider Enumeration Date:
07/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CALARA
Authorized Official First Name:
RITA
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGED CARE PLAN SPECIALIST
Authorized Official Telephone Number:
925-467-2811

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  228 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 03001658 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0609808 . This is a "NCPDP" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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