Provider Demographics
NPI:1336493048
Name:TIMO M QUICKERT MD LLC
Entity Type:Organization
Organization Name:TIMO M QUICKERT MD LLC
Other - Org Name:PREMIER VEIN & PAIN CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMO
Authorized Official - Middle Name:MATTHIAS
Authorized Official - Last Name:QUICKERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-672-6984
Mailing Address - Street 1:3438 TALIESIN WAY
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-9375
Mailing Address - Country:US
Mailing Address - Phone:970-672-4705
Mailing Address - Fax:
Practice Address - Street 1:4848 THOMPSON PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:JOHNSTOWN
Practice Address - State:CO
Practice Address - Zip Code:80534-6433
Practice Address - Country:US
Practice Address - Phone:970-800-4145
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-02
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NENA2253Medicare PIN