Provider Demographics
| NPI: | 1376912931 |
|---|---|
| Name: | PINNACLE MEDICAL PARTNERS II, LLC |
| Entity Type: | Organization |
| Organization Name: | PINNACLE MEDICAL PARTNERS II, LLC |
| Other - Org Name: | SOUTH DENVER OBGYN & MIDWIVES |
| Other - Org Type: | Doing Business As |
| Authorized Official - Title/Position: | CREDENTIALING SPECIALIST |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | CANDICE |
| Authorized Official - Middle Name: | R |
| Authorized Official - Last Name: | CHACON-JARAMILLO |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 720-439-2456 |
| Mailing Address - Street 1: | 8055 E TUFTS AVE |
| Mailing Address - Street 2: | |
| Mailing Address - City: | DENVER |
| Mailing Address - State: | CO |
| Mailing Address - Zip Code: | 80237-2854 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 303-357-2559 |
| Mailing Address - Fax: | 720-572-5112 |
| Practice Address - Street 1: | 7335 S PIERCE ST |
| Practice Address - Street 2: | |
| Practice Address - City: | LITTLETON |
| Practice Address - State: | CO |
| Practice Address - Zip Code: | 80128-4571 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 303-979-7200 |
| Practice Address - Fax: | 303-933-5265 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | Yes |
| Parent Organization LBN: | PINNACLE MEDICAL PARTNERS II, LLC |
| Parent Organization TIN: | <UNAVAIL> |
| Enumeration Date: | 2015-09-24 |
| Last Update Date: | 2018-06-16 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 208D00000X | Allopathic & Osteopathic Physicians | General Practice | Group - Multi-Specialty | |
| No | 176B00000X | Other Service Providers | Midwife | Group - Multi-Specialty | |
| No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
| No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
| No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
| No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty | |
| No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Multi-Specialty |
| No | 363LP0200X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics | Group - Multi-Specialty |
| No | 363LP2300X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care | Group - Multi-Specialty |
| No | 363LW0102X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health | Group - Multi-Specialty |
| No | 363LX0001X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Obstetrics & Gynecology | Group - Multi-Specialty |
| No | 367A00000X | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| CO | 9000152829 | Medicaid | |
| CO | 9000152759 | Medicaid | |
| CO | 9000152822 | Medicaid | |
| CO | 9000152828 | Medicaid | |
| CO | 9000152831 | Medicaid | |
| CO | 9000152821 | Medicaid | |
| CO | 475347 | Medicaid | |
| CO | 9000152941 | Medicaid | |
| CO | 9000153112 | Medicaid |
