1881131654 NPI number — 1ST ALLERGY ASTHMA AND PEDIATRICS TOO, INC.

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 1881131654 NPI number — 1ST ALLERGY ASTHMA AND PEDIATRICS TOO, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
1ST ALLERGY ASTHMA AND PEDIATRICS TOO, INC.
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:
1881131654
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/31/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6801 S YOSEMITE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CENTENNIAL
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80112-1406
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-773-9000
Provider Business Mailing Address Fax Number:
303-770-1449

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3150 E 3RD AVE STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80206-5247
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-870-2414
Provider Business Practice Location Address Fax Number:
720-870-2517
Provider Enumeration Date:
01/31/2017

Additional Information

Authorized Official

Authorized Official Last Name:
MUSHOVIC
Authorized Official First Name:
RONI
Authorized Official Middle Name:
G
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
303-773-9000

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 52481328 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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