1811504582 NPI number — COLORADO MEDICAL GROUP, PLLC

Table of content: (NPI 1811504582)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811504582 NPI number — COLORADO MEDICAL GROUP, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLORADO MEDICAL GROUP, PLLC
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:
UNITED VEIN & VASCULAR CENTERS
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:
1811504582
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3810 NORTHDALE BLVD STE 150
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33624-1871
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-961-1331
Provider Business Mailing Address Fax Number:
888-850-8316

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1044 S 88TH ST STE 105
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80027-9418
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-991-6117
Provider Business Practice Location Address Fax Number:
888-812-8191
Provider Enumeration Date:
09/28/2020

Additional Information

Authorized Official

Authorized Official Last Name:
WAZNI
Authorized Official First Name:
ALI
Authorized Official Middle Name:
N
Authorized Official Title or Position:
CHIEF ADMINISTRATION OFFICER
Authorized Official Telephone Number:
800-991-6117

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0129X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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