1225629199 NPI number — NEW WEST PHYSICIANS INC

Table of content: (NPI 1225629199)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225629199 NPI number — NEW WEST PHYSICIANS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW WEST PHYSICIANS 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:
NEW WEST DIABETES AND NUTRITION CENTER
Provider Other Organization Name Type Code:
3
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:
1225629199
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/29/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1707 COLE BLVD STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GOLDEN
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80401-3219
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-763-4900
Provider Business Mailing Address Fax Number:
303-763-5495

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1707 COLE BLVD STE 125
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GOLDEN
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80401-3220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-716-8039
Provider Business Practice Location Address Fax Number:
303-202-3895
Provider Enumeration Date:
02/02/2021

Additional Information

Authorized Official

Authorized Official Last Name:
HECKARD
Authorized Official First Name:
RHONDA
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING COORDINATOR
Authorized Official Telephone Number:
303-763-4900

Provider Taxonomy Codes

  • Taxonomy code: 163WD0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 163WN1003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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