1730377557 NPI number — ROBERT E. BENKERT, MD PC

Table of content: (NPI 1730377557)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730377557 NPI number — ROBERT E. BENKERT, MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROBERT E. BENKERT, MD 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:
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:
1730377557
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/02/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5728 S GALLUP ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LITTLETON
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80120-2193
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-431-3727
Provider Business Mailing Address Fax Number:
303-431-3692

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9201 W 44TH AVE
Provider Second Line Business Practice Location Address:
UNIT B
Provider Business Practice Location Address City Name:
WHEAT RIDGE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80033-3084
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-431-3727
Provider Business Practice Location Address Fax Number:
303-431-3692
Provider Enumeration Date:
10/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BENKERT
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
303-431-3727

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X , with the licence number:  33028 , 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: 113422100 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 97133 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: BE08741 . This is a "ANTHEM BLUE CROSS BLUE SH" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 04016366 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 290007401 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4140701 . This is a "AETNA PPO/POS" identifier . This identifiers is of the category "OTHER".




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