1851464523 NPI number — CHOA MD PC

Table of content: (NPI 1851464523)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851464523 NPI number — CHOA MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHOA MD 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:
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:
1851464523
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
320 E FONTANERO ST
Provider Second Line Business Mailing Address:
SUITE 308
Provider Business Mailing Address City Name:
COLORADO SPRINGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80907-7529
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-471-2462
Provider Business Mailing Address Fax Number:
719-574-4974

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
320 E FONTANERO ST
Provider Second Line Business Practice Location Address:
SUITE 308
Provider Business Practice Location Address City Name:
COLORADO SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80907-7529
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-986-9504
Provider Business Practice Location Address Fax Number:
719-574-4974
Provider Enumeration Date:
11/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COOK
Authorized Official First Name:
BRUCE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
719-471-2462

Provider Taxonomy Codes

  • Taxonomy code: 2080P0207X , 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: 1497767578 . This is a "THOMAS J SMITH MD" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 1497775142 . This is a "NPI BRUCE A COOK MD" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 1417959107 . This is a "NPI STEPHEN R PALMER MD" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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