Provider Demographics
NPI:1629136254
Name:GERALD C MCINTOSH MD
Entity Type:Organization
Organization Name:GERALD C MCINTOSH MD
Other - Org Name:NEUROLOGY ASSOCIATES OF NORTHERN COLORADO
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:CLINTON
Authorized Official - Last Name:MCINTOSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-482-4373
Mailing Address - Street 1:1221 E ELIZABETH ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-4065
Mailing Address - Country:US
Mailing Address - Phone:970-482-4373
Mailing Address - Fax:970-484-5682
Practice Address - Street 1:1221 E ELIZABETH ST
Practice Address - Street 2:SUITE 3
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-4065
Practice Address - Country:US
Practice Address - Phone:970-482-4373
Practice Address - Fax:970-484-5682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO09082735Medicaid
CODA6242OtherRAILROAD MEDICARE
COC484858Medicare PIN