1073561296 NPI number — RICHARD KUBISTA MD

Table of content: RICHARD KUBISTA MD (NPI 1073561296)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073561296 NPI number — RICHARD KUBISTA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KUBISTA
Provider First Name:
RICHARD
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1073561296
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1241 W MINERAL AVE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
LITTLETON
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80120-5685
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-759-0854
Provider Business Mailing Address Fax Number:
303-759-0864

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7700 S BROADWAY
Provider Second Line Business Practice Location Address:
LITTLETON ADVENTIST HOSPITAL, EMERGENCY DEPARTMENT
Provider Business Practice Location Address City Name:
LITTLETON
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80122-2602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-778-5666
Provider Business Practice Location Address Fax Number:
303-759-0864
Provider Enumeration Date:
05/04/2006

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: 207P00000X , with the licence number:  43873 , 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: 43521266 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com