Basic Information
| Provider Information | |||||||||
| NPI: | 1720038946 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HCA HEALTHONE LLC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | PRESBYTERIAN/ST. LUKE'S MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1719 E 19TH AVE | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802181235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3038396100 | ||||||||
| FaxNumber: | 3038692428 | ||||||||
| Practice Location | |||||||||
| Address1: | 1719 E 19TH AVE | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802181235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3038396100 | ||||||||
| FaxNumber: | 3038692428 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2006 | ||||||||
| LastUpdateDate: | 05/27/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | COLLIER | ||||||||
| AuthorizedOfficialFirstName: | SHARI | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 7207547009 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 05/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 0060014 | 05 | VT | MEDICAID | 012557401 | 05 | MO | MEDICAID | 071696101 | 05 | TX | MEDICAID | 3021151 | 05 | WA | MEDICAID | A1226 | 05 | NM | MEDICAID | 05014006 | 05 | CO | MEDICAID | 060014 | 01 | KAISWER SENIOR ADVANTAGE | OTHER | 100103460B | 05 | KS | MEDICAID | HS967OP | 05 | AK | MEDICAID | XHSP30078 | 05 | CA | MEDICAID | 0128310 | 05 | SD | MEDICAID | 1748153 | 05 | LA | MEDICAID | 182250100 | 05 | MN | MEDICAID | 267739 | 05 | OR | MEDICAID | 304709773 | 05 | MI | MEDICAID | 901290700 | 05 | FL | MEDICAID | 02008597 | 05 | NY | MEDICAID | 02223 | 05 | ND | MEDICAID | 100704510C | 05 | OK | MEDICAID | 200246860A | 05 | IN | MEDICAID | PRE0014N | 05 | AL | MEDICAID | 05014006 | 01 | DENVER HEALTH MCO CHOICE | OTHER | 108787800 | 05 | WY | MEDICAID | 4077202 | 05 | NJ | MEDICAID | 87012 | 05 | TN | MEDICAID | 01200005 | 05 | KY | MEDICAID | 3810004135 | 05 | WV | MEDICAID | 002170700 | 05 | ID | MEDICAID | 003112670 | 05 | CT | MEDICAID | 00713853X | 05 | GA | MEDICAID | 01617524 | 05 | PA | MEDICAID | 11192A | 05 | SC | MEDICAID | 378073604 | 01 | FEDERAL WORKERS COMP | OTHER | 9600014 | 05 | NC | MEDICAID | 00005CO | 01 | BLUE CROSS | OTHER | 00600148 | 05 | VA | MEDICAID | 0376409 | 05 | OH | MEDICAID | 0414596 | 05 | MT | MEDICAID | 0568543 | 05 | IA | MEDICAID | 0707828 | 01 | AETNA HMO PPO | OTHER | 1010565 | 05 | MA | MEDICAID | 525561 | 05 | AZ | MEDICAID |