Provider Demographics
NPI:1093784357
Name:RITENOUR, ANITA R (MD)
Entity Type:Individual
Prefix:DR
First Name:ANITA
Middle Name:R
Last Name:RITENOUR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 EAST KEN PRATT PARKWAY
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80504
Mailing Address - Country:US
Mailing Address - Phone:720-718-7000
Mailing Address - Fax:
Practice Address - Street 1:1750 E KEN PRATT BLVD
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80504-5311
Practice Address - Country:US
Practice Address - Phone:720-718-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2017-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH10312207R00000X
CODR0058855207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHP00014354OtherRR MEDICARE
NH30200035Medicaid
NHRE4940Medicare PIN
NH30200035Medicaid
NH0103675Y0NH02OtherANTHEM ACES 3
NH278570OtherCIGNA
NHHLO046OtherHPHC
NH0407212OtherUNITED HC
NH406454OtherTUFTS
NHG76466OtherANTHEM REFERRING PIN
NH30200035Medicaid