Provider Demographics
NPI:1083622005
Name:ARNOLD PROFESSIONAL LLC
Entity Type:Organization
Organization Name:ARNOLD PROFESSIONAL LLC
Other - Org Name:VILLAGE FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:W
Authorized Official - Last Name:ARNOLD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:720-488-0055
Mailing Address - Street 1:5161 E ARAPAHOE RD
Mailing Address - Street 2:#290
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122
Mailing Address - Country:US
Mailing Address - Phone:720-488-0055
Mailing Address - Fax:720-488-3955
Practice Address - Street 1:5161 E ARAPAHOE RD
Practice Address - Street 2:#290
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80122
Practice Address - Country:US
Practice Address - Phone:720-488-0055
Practice Address - Fax:720-488-3955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO60521040Medicaid
COC800158Medicare PIN