Provider Demographics
NPI:1679776777
Name:ASPEN CLINIC INTERNAL MEDICINE ASSOCIATES
Entity type:Organization
Organization Name:ASPEN CLINIC INTERNAL MEDICINE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ZIMET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-544-1131
Mailing Address - Street 1:400 WEST MAIN SUITE 100
Mailing Address - Street 2:
Mailing Address - City:ASPEN
Mailing Address - State:CO
Mailing Address - Zip Code:81611
Mailing Address - Country:US
Mailing Address - Phone:970-544-1131
Mailing Address - Fax:844-384-5032
Practice Address - Street 1:400 WEST MAIN SUITE 100
Practice Address - Street 2:
Practice Address - City:ASPEN
Practice Address - State:CO
Practice Address - Zip Code:81611
Practice Address - Country:US
Practice Address - Phone:970-544-1131
Practice Address - Fax:844-384-5032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01194877Medicaid
CO01308642Medicaid
CO01183839Medicaid
CO01194877Medicaid
69904Medicare ID - Type Unspecified
CO01308642Medicaid
CO69944Medicare ID - Type Unspecified
CO01183839Medicaid
CO69934Medicare ID - Type Unspecified
CO69944Medicare ID - Type Unspecified