1801020706 NPI number — JOE DALLAS HAGEWOOD R.EP T.

Table of content: JOE DALLAS HAGEWOOD R.EP T. (NPI 1801020706)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801020706 NPI number — JOE DALLAS HAGEWOOD R.EP T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAGEWOOD
Provider First Name:
JOE
Provider Middle Name:
DALLAS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
R.EP T.
Provider Gender Code:
M

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:
1801020706
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/06/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
777 E GIRARD AVE STE 250
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ENGLEWOOD
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80113-2784
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
720-214-2549
Provider Business Mailing Address Fax Number:
303-744-7876

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4321 CAROTHERS PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRANKLIN
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37067-5909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-435-5000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/06/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 246ZE0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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