1932284684 NPI number — SARAH ANNE LACEY MD

Table of content: SARAH ANNE LACEY MD (NPI 1932284684)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932284684 NPI number — SARAH ANNE LACEY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LACEY
Provider First Name:
SARAH
Provider Middle Name:
ANNE
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:
PILAROWSKI
Provider Other First Name:
SARAH
Provider Other Middle Name:
LACEY
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:
1932284684
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/25/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4500 E 9TH AVE #300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-756-0101
Provider Business Mailing Address Fax Number:
303-756-1408

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4500 E 9TH AVE #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:
80220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-941-1778
Provider Business Practice Location Address Fax Number:
303-756-1408
Provider Enumeration Date:
10/25/2006

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: 208000000X , with the licence number:  39955 , 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: 78389232 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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