Provider Demographics
NPI:1194863449
Name:MICHAEL CLARK BAGLEY CO
Entity Type:Organization
Organization Name:MICHAEL CLARK BAGLEY CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.O.
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:BAGLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:303-655-3003
Mailing Address - Street 1:1860 E EGBERT ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-2475
Mailing Address - Country:US
Mailing Address - Phone:303-655-3003
Mailing Address - Fax:303-655-3005
Practice Address - Street 1:1860 E EGBERT ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-2475
Practice Address - Country:US
Practice Address - Phone:303-655-3003
Practice Address - Fax:303-655-3005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR45154207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H44880Medicare UPIN