1760778245 NPI number — DR. T RANDALL ELDRIDGE DC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760778245 NPI number — DR. T RANDALL ELDRIDGE DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. T RANDALL ELDRIDGE DC
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:
1760778245
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/23/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7535 E HAMPDEN AVENUE
Provider Second Line Business Mailing Address:
SUITE 405
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80231
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-798-9000
Provider Business Mailing Address Fax Number:
303-996-2660

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7535 E HAMPDEN AVENUE
Provider Second Line Business Practice Location Address:
SUITE 405
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-798-9000
Provider Business Practice Location Address Fax Number:
303-996-2660
Provider Enumeration Date:
06/23/2011

Additional Information

Authorized Official

Authorized Official Last Name:
SCOTT
Authorized Official First Name:
MELANIE
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
303-758-9000

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  2552 , 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)





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