Basic Information
| Provider Information | |||||||||
| NPI: | 1427397652 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COLUMBINE PHYSICIAN COVERAGE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1129 | ||||||||
| Address2: | |||||||||
| City: | DELTA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 814161129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9708742470 | ||||||||
| FaxNumber: | 9708742475 | ||||||||
| Practice Location | |||||||||
| Address1: | 1501 E 3RD ST | ||||||||
| Address2: | |||||||||
| City: | DELTA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 814162815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9708747681 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2013 | ||||||||
| LastUpdateDate: | 02/07/2013 | ||||||||
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| AuthorizedOfficialLastName: | BERKOSKY | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 9707786708 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 24338 | CO | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.