1790085892 NPI number — HARVARD AVENUE INTERNAL MEDICINE

Table of content: MS. PATRICIA A. MOORE LCSW (NPI 1164431029)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790085892 NPI number — HARVARD AVENUE INTERNAL MEDICINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HARVARD AVENUE INTERNAL MEDICINE
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:
1790085892
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
850 E HARVARD AVE
Provider Second Line Business Mailing Address:
SUITE 455
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80210-5073
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-722-2724
Provider Business Mailing Address Fax Number:
303-722-3121

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
850 E HARVARD AVE
Provider Second Line Business Practice Location Address:
SUITE 455
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80210-5073
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-722-2724
Provider Business Practice Location Address Fax Number:
303-722-3121
Provider Enumeration Date:
10/24/2010

Additional Information

Authorized Official

Authorized Official Last Name:
HO
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
JAMES
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
303-722-2724

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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