Provider Demographics
NPI:1508035403
Name:KEVIN K HOWELL
Entity Type:Organization
Organization Name:KEVIN K HOWELL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:K
Authorized Official - Last Name:HOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:970-242-2429
Mailing Address - Street 1:1060 ORCHARD AVE
Mailing Address - Street 2:STE F
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-2997
Mailing Address - Country:US
Mailing Address - Phone:970-242-2429
Mailing Address - Fax:
Practice Address - Street 1:1060 ORCHARD AVE
Practice Address - Street 2:STE F
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-2997
Practice Address - Country:US
Practice Address - Phone:970-242-2429
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO03425045Medicaid
CO03425045Medicaid