Provider Demographics
NPI:1619088176
Name:WESTERN NEPHROLOGY & METABOLIC BONE DISEASE, P.C.
Entity Type:Organization
Organization Name:WESTERN NEPHROLOGY & METABOLIC BONE DISEASE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFFO
Authorized Official - Prefix:
Authorized Official - First Name:CHERMAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEYKO
Authorized Official - Suffix:
Authorized Official - Credentials:CFFO
Authorized Official - Phone:303-456-5495
Mailing Address - Street 1:4891 INDEPENDENCE STREET
Mailing Address - Street 2:SUITE 120
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-6713
Mailing Address - Country:US
Mailing Address - Phone:303-456-5495
Mailing Address - Fax:303-456-7490
Practice Address - Street 1:5265 VANCE STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80002
Practice Address - Country:US
Practice Address - Phone:303-232-3366
Practice Address - Fax:303-232-8734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC225608Medicare PIN
CO=========OtherTAX ID NUMBER