Provider Demographics
NPI:1053423186
Name:NORTH COLORADO EAR NOSE & THROAT
Entity type:Organization
Organization Name:NORTH COLORADO EAR NOSE & THROAT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:REINERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-356-4646
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:KERSEY
Mailing Address - State:CO
Mailing Address - Zip Code:80644
Mailing Address - Country:US
Mailing Address - Phone:970-356-4646
Mailing Address - Fax:970-356-2041
Practice Address - Street 1:2528 16TH ST
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-4955
Practice Address - Country:US
Practice Address - Phone:970-356-4646
Practice Address - Fax:970-356-2041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04651048Medicaid
CONO65104OtherANTHEM BCBS
COC65104Medicare PIN