Provider Demographics
NPI:1538458229
Name:KAISER PERMANENTE
Entity Type:Organization
Organization Name:KAISER PERMANENTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN- TELEPHONE TRIAGE
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENNA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:RUCKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:303-464-9579
Mailing Address - Street 1:14341 CRAFTSMAN WAY
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80023-4040
Mailing Address - Country:US
Mailing Address - Phone:303-464-9579
Mailing Address - Fax:
Practice Address - Street 1:10065 E HARVARD AVE
Practice Address - Street 2:STE 400
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-5968
Practice Address - Country:US
Practice Address - Phone:303-614-1400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-03
Last Update Date:2011-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO127276261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center