Basic Information
| Provider Information | |||||||||
| NPI: | 1851562185 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DENVER NEPHROLOGISTS, PC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | COLORADO KIDNEY CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 130 RAMPART WAY | ||||||||
| Address2: | SUITE 300B | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802306451 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033274700 | ||||||||
| FaxNumber: | 3033274711 | ||||||||
| Practice Location | |||||||||
| Address1: | 4545 E 9TH AVE | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802203901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3039910993 | ||||||||
| FaxNumber: | 3035316583 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2008 | ||||||||
| LastUpdateDate: | 05/25/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | IRWIN | ||||||||
| AuthorizedOfficialFirstName: | ELIZABETH | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 3033274700 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | DENVER NEPHROLOGISTS, PC | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 05/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 35980753 | 05 | CO | MEDICAID | CT0364 | 01 | RAILROAD MEDICARE | OTHER |