Provider Demographics
NPI:1013544014
Name:CENTURA HEALTH
Entity Type:Organization
Organization Name:CENTURA HEALTH
Other - Org Name:CENTURA HEALTH EMERGENCY AND URGENT CARE - LAKEWOOD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, AMBULATORY SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:303-765-6998
Mailing Address - Street 1:PO BOX 801666
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-1666
Mailing Address - Country:US
Mailing Address - Phone:800-953-0104
Mailing Address - Fax:303-765-6670
Practice Address - Street 1:3280 S WADSWORTH BLVD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80227-5002
Practice Address - Country:US
Practice Address - Phone:303-649-3620
Practice Address - Fax:303-649-3621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-27
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
1083166623OtherOLD NPI