Provider Demographics
NPI:1366506131
Name:HAMPDEN MEDICAL GROUP
Entity Type:Organization
Organization Name:HAMPDEN MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUBBARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-789-2251
Mailing Address - Street 1:221 E HAMPDEN AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-2620
Mailing Address - Country:US
Mailing Address - Phone:303-789-2251
Mailing Address - Fax:303-789-2505
Practice Address - Street 1:221 E HAMPDEN AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2620
Practice Address - Country:US
Practice Address - Phone:303-789-2251
Practice Address - Fax:303-789-2505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DG1678OtherRAILROAD MEDICARE
CO04006524Medicaid
DG1678OtherRAILROAD MEDICARE