Provider Demographics
NPI:1558506477
Name:V. MICHAEL BARKETT, PROFESSIONAL CORP
Entity Type:Organization
Organization Name:V. MICHAEL BARKETT, PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VANDER
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BARKETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-230-2000
Mailing Address - Street 1:550 W HWY 50
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CO
Mailing Address - Zip Code:81201-2238
Mailing Address - Country:US
Mailing Address - Phone:719-530-2000
Mailing Address - Fax:719-530-2055
Practice Address - Street 1:550 W HWY 50
Practice Address - Street 2:
Practice Address - City:SALIDA
Practice Address - State:CO
Practice Address - Zip Code:81201-2238
Practice Address - Country:US
Practice Address - Phone:719-530-2000
Practice Address - Fax:719-530-2055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-05
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO23436208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01234368Medicaid
CO01234368Medicaid