Provider Demographics
NPI:1093992224
Name:RITTEL & JOSEPHSD.O. PROFESSIONAL LLC
Entity Type:Organization
Organization Name:RITTEL & JOSEPHSD.O. PROFESSIONAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:JOSEPHS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:303-447-0550
Mailing Address - Street 1:3055 47TH STREET
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-5469
Mailing Address - Country:US
Mailing Address - Phone:303-447-0550
Mailing Address - Fax:303-447-9570
Practice Address - Street 1:3055 47TH STREET
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-5469
Practice Address - Country:US
Practice Address - Phone:303-447-0550
Practice Address - Fax:303-447-9570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-30
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
CO28684207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01286848Medicaid
CO37284541Medicaid
COCJ4808Medicare PIN
COCJ4808Medicare UPIN
COE46945Medicare UPIN