Basic Information
| Provider Information | |||||||||
| NPI: | 1134381676 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INTERNAL MEDICINE, PULMONARY & CRITICAL CARE ASSOCIATES, LLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1241 W MINERAL AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | LITTLETON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801205685 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037590854 | ||||||||
| FaxNumber: | 3037590864 | ||||||||
| Practice Location | |||||||||
| Address1: | 2525 S DOWNING ST | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802105817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037785666 | ||||||||
| FaxNumber: | 3037785787 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2008 | ||||||||
| LastUpdateDate: | 06/26/2008 | ||||||||
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| AuthorizedOfficialLastName: | LONG | ||||||||
| AuthorizedOfficialFirstName: | TERESA | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3037590854 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207RP1001X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207RS0012X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine | 207RC0200X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | ---------002 | 05 | UT | MEDICAID | 33959307 | 05 | CO | MEDICAID | 7134711 | 05 | WA | MEDICAID | 10025360500 | 05 | NE | MEDICAID | 10025360300 | 05 | NE | MEDICAID | ---------00 | 05 | NE | MEDICAID | 122155800 | 05 | WY | MEDICAID | 200389130A | 05 | KS | MEDICAID | 0050096 | 05 | NM | MEDICAID | 10025360200 | 05 | NE | MEDICAID | 200088570A | 05 | OK | MEDICAID | 10025360400 | 05 | NE | MEDICAID |