Basic Information
| Provider Information | |||||||||
| NPI: | 1821042979 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HCA HEALTHONE LLC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | NORTH SUBURBAN MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 9191 GRANT ST | ||||||||
| Address2: | |||||||||
| City: | THORNTON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802294361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034517800 | ||||||||
| FaxNumber: | 3034504458 | ||||||||
| Practice Location | |||||||||
| Address1: | 9191 GRANT ST | ||||||||
| Address2: | |||||||||
| City: | THORNTON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802294361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034517800 | ||||||||
| FaxNumber: | 3034504584 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2006 | ||||||||
| LastUpdateDate: | 07/15/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ESPARZA | ||||||||
| AuthorizedOfficialFirstName: | NATHAN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 3034504445 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 07/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 00865587X | 05 | GA | MEDICAID | 05065008 | 05 | CO | MEDICAID | 0913248 | 05 | OH | MEDICAID | 152296105 | 05 | AR | MEDICAID | 1700282 | 05 | LA | MEDICAID | 378073605 | 01 | FEDERAL WORKERS COMP | OTHER | 591611966001 | 05 | UT | MEDICAID | 707937 | 05 | AZ | MEDICAID | 116089300 | 05 | WY | MEDICAID | 20001862 | 05 | NH | MEDICAID | 3001658 | 05 | WA | MEDICAID | 805605700 | 05 | ID | MEDICAID | HS137OP | 05 | AK | MEDICAID | 0001036705 | 05 | DE | MEDICAID | 01200013 | 05 | KY | MEDICAID | 11063B | 05 | SC | MEDICAID | 910368600 | 05 | FL | MEDICAID | 000354 | 05 | OR | MEDICAID | 02462 | 05 | ND | MEDICAID | 05065008 | 01 | DENVER HEALTH MCO | OTHER | 100103460D | 05 | KS | MEDICAID | 4107584 | 05 | MT | MEDICAID | NOR0065N | 05 | AL | MEDICAID | 100704510H | 05 | OK | MEDICAID | 16887408 | 05 | MO | MEDICAID | 304709693 | 05 | MI | MEDICAID | 9600065 | 05 | NC | MEDICAID | 001288244 | 05 | NV | MEDICAID | 0129222 | 05 | SD | MEDICAID | 02419689 | 05 | NY | MEDICAID | 0695851 | 01 | AETNA HMO PPO | OTHER | 200417670A | 05 | IN | MEDICAID | 283055800 | 05 | MN | MEDICAID | 81552200 | 05 | WI | MEDICAID | 060065 | 01 | KAISER SENIOR ADVANTAGE | OTHER | 00051CO | 01 | BLUE CROSS | OTHER | 00076944 | 05 | NM | MEDICAID | 0581496 | 05 | IA | MEDICAID | 108674602 | 05 | TX | MEDICAID | 7000651 | 05 | MA | MEDICAID | XHSP33053 | 05 | CA | MEDICAID |