Provider Demographics
NPI:1043858889
Name:NATIONAL JEWISH SOUTH DENVER
Entity Type:Organization
Organization Name:NATIONAL JEWISH SOUTH DENVER
Other - Org Name:NJH SOUTH DENVER
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL STAFF SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:DIRECTOR
Authorized Official - Phone:303-388-4461
Mailing Address - Street 1:1400 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-2762
Mailing Address - Country:US
Mailing Address - Phone:303-388-4461
Mailing Address - Fax:303-270-2366
Practice Address - Street 1:499 E HAMPDEN AVE STE 300
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2793
Practice Address - Country:US
Practice Address - Phone:303-788-8500
Practice Address - Fax:303-788-8505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-11
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1043858889Medicaid
CO1326015777Medicaid