1164027694 NPI number — TEAM SELECT MOBILE THERAPY OF COLORADO LLC

Table of content: (NPI 1164027694)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164027694 NPI number — TEAM SELECT MOBILE THERAPY OF COLORADO LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TEAM SELECT MOBILE THERAPY OF COLORADO LLC
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:
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:
1164027694
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/07/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2999 N 44TH ST STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85018-7247
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-382-8500
Provider Business Mailing Address Fax Number:
602-253-5656

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3025 S PARKER RD STE 930
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AURORA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80014-2948
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-222-1388
Provider Business Practice Location Address Fax Number:
303-648-4191
Provider Enumeration Date:
12/02/2020

Additional Information

Authorized Official

Authorized Official Last Name:
LOVELL
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
602-382-8500

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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