1841249968 NPI number — DENA SUE SHEPPARD-MADDEN MD

Table of content: DENA SUE SHEPPARD-MADDEN MD (NPI 1841249968)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841249968 NPI number — DENA SUE SHEPPARD-MADDEN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHEPPARD-MADDEN
Provider First Name:
DENA
Provider Middle Name:
SUE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHEPPARD
Provider Other First Name:
DENA
Provider Other Middle Name:
SUE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1841249968
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/16/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
401 10TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BERTHOUD
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80513-1381
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-532-4910
Provider Business Mailing Address Fax Number:
970-532-2850

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 10TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BERTHOUD
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80513-1381
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-532-4910
Provider Business Practice Location Address Fax Number:
970-532-2850
Provider Enumeration Date:
05/08/2006

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: 207Q00000X , with the licence number:  28969 , 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: 84132889806 . This is a "PACIFICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 84132889807 . This is a "SECURE HORIZONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01289693 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 84132889801 . This is a "ROCKY MOUNTAIN HEALTH PLA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 84132889806 . This is a "SECURE HORIZONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 84132889807 . This is a "PACIFICARE" identifier . This identifiers is of the category "OTHER".




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