Basic Information
| Provider Information | |||||||||
| NPI: | 1417538539 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RURAL PHYSICIANS GROUP - PANNU PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5575 DTC PKWY STE 225 | ||||||||
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| City: | GREENWOOD VILLAGE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801113073 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 615 FAIRHURST ST | ||||||||
| Address2: | |||||||||
| City: | STERLING | ||||||||
| State: | CO | ||||||||
| PostalCode: | 807514523 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033901924 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2021 | ||||||||
| LastUpdateDate: | 11/12/2021 | ||||||||
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| AuthorizedOfficialLastName: | PANNU | ||||||||
| AuthorizedOfficialFirstName: | SUKHBIR | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7029333266 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 11/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 9000150101 | 05 | CO | MEDICAID |