Provider Demographics
NPI:1164604211
Name:WARREN TRIPP, M.D. P.C.
Entity Type:Organization
Organization Name:WARREN TRIPP, M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELI
Authorized Official - Middle Name:
Authorized Official - Last Name:BROPHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-442-6260
Mailing Address - Street 1:2800 FOLSOM ST STE C
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-3768
Mailing Address - Country:US
Mailing Address - Phone:303-442-6260
Mailing Address - Fax:
Practice Address - Street 1:2800 FOLSOM ST STE C
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3768
Practice Address - Country:US
Practice Address - Phone:303-442-6260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO25330174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04013223Medicaid
COCA0008Medicare PIN