1649239575 NPI number — TIMBERVIEW CLINIC

Table of content: (NPI 1649239575)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649239575 NPI number — TIMBERVIEW CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TIMBERVIEW CLINIC
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:
1649239575
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/30/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1400 S POTOMAC ST
Provider Second Line Business Mailing Address:
SUITE 215
Provider Business Mailing Address City Name:
AURORA
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80012-4528
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-306-1039
Provider Business Mailing Address Fax Number:
303-306-1050

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 S POTOMAC ST
Provider Second Line Business Practice Location Address:
SUITE 215
Provider Business Practice Location Address City Name:
AURORA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80012-4528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-306-1039
Provider Business Practice Location Address Fax Number:
303-306-1050
Provider Enumeration Date:
03/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SHARP
Authorized Official First Name:
RON
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
303-269-4464

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  208011, 206336 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208000000X , with the licence number: 77105,77106 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 12721042 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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