Provider Demographics
NPI:1275813297
Name:PREFERRED PROVIDER SERVICES, LLC
Entity Type:Organization
Organization Name:PREFERRED PROVIDER SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BOBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LIVINGSTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-481-7030
Mailing Address - Street 1:3025 S PARKER RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-2911
Mailing Address - Country:US
Mailing Address - Phone:303-481-7030
Mailing Address - Fax:303-745-7665
Practice Address - Street 1:3025 S PARKER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-2911
Practice Address - Country:US
Practice Address - Phone:303-481-7030
Practice Address - Fax:303-745-7665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-22
Last Update Date:2014-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01789759Medicaid
CO01789759Medicaid