Provider Demographics
NPI:1619633237
Name:CO PACS 2 PC
Entity Type:Organization
Organization Name:CO PACS 2 PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER ENROLLMENT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKERINK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-500-1325
Mailing Address - Street 1:1643 NW 136TH AVENUE
Mailing Address - Street 2:BUILDING H, SUITE 100 MSC 11607-001
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2857
Mailing Address - Country:US
Mailing Address - Phone:865-500-1325
Mailing Address - Fax:
Practice Address - Street 1:14699 E HAMPDEN AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-3903
Practice Address - Country:US
Practice Address - Phone:303-693-0111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty