Basic Information
| Provider Information | |||||||||
| NPI: | 1316169741 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ACI NETWORK | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 3575 S SHERMAN ST STE 3 | ||||||||
| Address2: | |||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801133798 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037617600 | ||||||||
| FaxNumber: | 3037621053 | ||||||||
| Practice Location | |||||||||
| Address1: | 3575 S SHERMAN ST STE 3 | ||||||||
| Address2: | |||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801133798 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037617600 | ||||||||
| FaxNumber: | 3037621053 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | NORTHEY | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | JAMES | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 3037617600 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | M.S.M. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 305R00000X | Y | Managed Care Organizations | Preferred Provider Organization |
No ID Information.