Provider Demographics
NPI:1174855654
Name:EXEMPLA DIABETES CENTER
Entity Type:Organization
Organization Name:EXEMPLA DIABETES CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EDUCATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:S
Authorized Official - Last Name:HAM
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED DIETITIAN
Authorized Official - Phone:303-403-7930
Mailing Address - Street 1:3455 LUTHERAN PKWY STE 270
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-6034
Mailing Address - Country:US
Mailing Address - Phone:303-403-7930
Mailing Address - Fax:
Practice Address - Street 1:3455 LUTHERAN PKWY STE 270
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-6034
Practice Address - Country:US
Practice Address - Phone:303-403-7930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-08
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO05669006282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital