Provider Demographics
NPI:1235324682
Name:DAVID C. LONGCOPE, MD, PC
Entity Type:Organization
Organization Name:DAVID C. LONGCOPE, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LONGCOPE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-377-6401
Mailing Address - Street 1:4600 HALE PKWY
Mailing Address - Street 2:SUITE 430
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-4020
Mailing Address - Country:US
Mailing Address - Phone:303-377-6401
Mailing Address - Fax:303-377-6951
Practice Address - Street 1:4600 HALE PKWY
Practice Address - Street 2:SUITE 430
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-4020
Practice Address - Country:US
Practice Address - Phone:303-377-6401
Practice Address - Fax:303-377-6951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO44105208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO89158288Medicaid
COC804413Medicare PIN
CO89158288Medicaid