Provider Demographics
NPI:1366673188
Name:COLORADO PLAIN PHYSICIAN PRACTICES, LLC
Entity Type:Organization
Organization Name:COLORADO PLAIN PHYSICIAN PRACTICES, LLC
Other - Org Name:COLORADO PLAINS GENERAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:VAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-867-7900
Mailing Address - Street 1:1000 LINCOLN ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:FORT MORGAN
Mailing Address - State:CO
Mailing Address - Zip Code:80701-3290
Mailing Address - Country:US
Mailing Address - Phone:970-542-4371
Mailing Address - Fax:970-542-4373
Practice Address - Street 1:1000 LINCOLN ST
Practice Address - Street 2:SUITE 208
Practice Address - City:FORT MORGAN
Practice Address - State:CO
Practice Address - Zip Code:80701-3290
Practice Address - Country:US
Practice Address - Phone:970-542-4371
Practice Address - Fax:970-542-4373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-28
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC804561Medicare PIN