Provider Demographics
NPI:1073836029
Name:KARL HAPCIC, MD, LLC
Entity Type:Organization
Organization Name:KARL HAPCIC, MD, LLC
Other - Org Name:PINON SURGICAL ARTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARL
Authorized Official - Middle Name:J
Authorized Official - Last Name:HAPCIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DDS
Authorized Official - Phone:719-564-5888
Mailing Address - Street 1:PO BOX 602
Mailing Address - Street 2:
Mailing Address - City:GALLATIN GATEWAY
Mailing Address - State:MT
Mailing Address - Zip Code:59730-0602
Mailing Address - Country:US
Mailing Address - Phone:406-763-4495
Mailing Address - Fax:406-763-4495
Practice Address - Street 1:1315 S PUEBLO BLVD STE 110
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81005-2192
Practice Address - Country:US
Practice Address - Phone:719-564-5888
Practice Address - Fax:719-564-1158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-04
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO36597174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COH25084Medicare UPIN