1992949481 NPI number — DR. BENJAMIN WOERNER CARELOCK DPM

Table of content: (NPI 1396148375)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992949481 NPI number — DR. BENJAMIN WOERNER CARELOCK DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARELOCK
Provider First Name:
BENJAMIN
Provider Middle Name:
WOERNER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CARELOCK
Provider Other First Name:
BENJAMIN
Provider Other Middle Name:
W.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPM
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1992949481
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/03/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 130
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRUITA
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81521-0130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-858-2186
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
281 N PLUM ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRUITA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81521-2100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-858-2530
Provider Business Practice Location Address Fax Number:
970-858-1196
Provider Enumeration Date:
04/28/2009

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: 213ES0103X , with the licence number:  POD.0000730 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 213ES0103X , with the licence number: 8606148-0501 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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