Provider Demographics
NPI:1598128266
Name:EDWARD J HEPWORTH MD PC
Entity Type:Organization
Organization Name:EDWARD J HEPWORTH MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:HEPWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-517-8283
Mailing Address - Street 1:3481 E KENTUCKY AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-4931
Mailing Address - Country:US
Mailing Address - Phone:303-517-8283
Mailing Address - Fax:
Practice Address - Street 1:3150 E 3RD AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-5245
Practice Address - Country:US
Practice Address - Phone:303-517-8283
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-31
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR43375207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO78182239Medicaid
CO78182239Medicaid