Provider Demographics
NPI:1467763482
Name:BACHUS PSYCHIATRY AND STRESS MANAGEMENT
Entity Type:Organization
Organization Name:BACHUS PSYCHIATRY AND STRESS MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WILLIAM KIRKLAND
Authorized Official - Last Name:BACHUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:720-854-4752
Mailing Address - Street 1:9220 KIMMER DR
Mailing Address - Street 2:SUITE 170
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-2878
Mailing Address - Country:US
Mailing Address - Phone:303-768-8100
Mailing Address - Fax:303-768-8585
Practice Address - Street 1:9220 KIMMER DR
Practice Address - Street 2:SUITE 170
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-2878
Practice Address - Country:US
Practice Address - Phone:303-768-8100
Practice Address - Fax:303-768-8585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-24
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO445332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COF48833Medicare UPIN