1851464523 NPI number — CHOA MD 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 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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