Provider Demographics
NPI:1578332243
Name:ANTHEM PRIMARY CARE PLLC
Entity Type:Organization
Organization Name:ANTHEM PRIMARY CARE PLLC
Other - Org Name:ANTHEM PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:TEJAS
Authorized Official - Middle Name:
Authorized Official - Last Name:TRIPATHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:720-456-5542
Mailing Address - Street 1:1660 W 130TH CT
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80234-2791
Mailing Address - Country:US
Mailing Address - Phone:720-624-6323
Mailing Address - Fax:
Practice Address - Street 1:16677 LOWELL BLVD STE 100
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80023-8053
Practice Address - Country:US
Practice Address - Phone:720-624-6323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-22
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty