1770785131 NPI number — HIGH COUNTRY HEALTH CARE PC

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 1770785131 NPI number — HIGH COUNTRY HEALTH CARE PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HIGH COUNTRY HEALTH CARE 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:
1770785131
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 911416
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80291-1416
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-352-7366
Provider Business Mailing Address Fax Number:
970-668-6546

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
265 TANGLEWOOD LANE
Provider Second Line Business Practice Location Address:
STE. W-3
Provider Business Practice Location Address City Name:
SILVERTHORNE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80498
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-668-1791
Provider Business Practice Location Address Fax Number:
970-668-1792
Provider Enumeration Date:
06/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
COLDAGELLI
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATIVE ASSISTANT
Authorized Official Telephone Number:
970-668-1791

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 240227500 . This is a "WC US DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: HIB5808 . This is a "BCBS CO BLUE CARD CLAIMS" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 04017646 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: HIB5808 . This is a "ANTHEM BCBS" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: M22040 . This is a "WC RISKO INSURANCE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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