Basic Information
Provider Information | |||||||||
NPI: | 1558506477 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | V. MICHAEL BARKETT, PROFESSIONAL CORP | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 550 W HWY 50 | ||||||||
Address2: |   | ||||||||
City: | SALIDA | ||||||||
State: | CO | ||||||||
PostalCode: | 812012238 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7195302000 | ||||||||
FaxNumber: | 7195302055 | ||||||||
Practice Location | |||||||||
Address1: | 550 W HWY 50 | ||||||||
Address2: |   | ||||||||
City: | SALIDA | ||||||||
State: | CO | ||||||||
PostalCode: | 812012238 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7195302000 | ||||||||
FaxNumber: | 7195302055 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/05/2008 | ||||||||
LastUpdateDate: | 07/26/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | BARKETT | ||||||||
AuthorizedOfficialFirstName: | VANDER | ||||||||
AuthorizedOfficialMiddleName: | MICHAEL | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
AuthorizedOfficialTelephone: | 7192302000 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | M.D. | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 23436 | CO | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |   |
ID Information
ID | Type | State | Issuer | Description | 01234368 | 05 | CO |   | MEDICAID |