Basic Information
| Provider Information | |||||||||
| NPI: | 1275813297 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PREFERRED PROVIDER SERVICES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3025 S PARKER RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800142911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034817030 | ||||||||
| FaxNumber: | 3037457665 | ||||||||
| Practice Location | |||||||||
| Address1: | 3025 S PARKER RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800142911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034817030 | ||||||||
| FaxNumber: | 3037457665 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2011 | ||||||||
| LastUpdateDate: | 03/30/2014 | ||||||||
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| AuthorizedOfficialLastName: | LIVINGSTON | ||||||||
| AuthorizedOfficialFirstName: | BOBBIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3034817030 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0300X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 01789759 | 05 | CO | MEDICAID |