Provider Demographics
NPI:1639181126
Name:NINTH AVENUE INTERNAL MEDICINE LLC
Entity Type:Organization
Organization Name:NINTH AVENUE INTERNAL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WITTEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-394-2152
Mailing Address - Street 1:4500 E 9TH AVE
Mailing Address - Street 2:SUITE 140
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-3900
Mailing Address - Country:US
Mailing Address - Phone:303-394-2152
Mailing Address - Fax:303-394-2496
Practice Address - Street 1:4500 E 9TH AVE
Practice Address - Street 2:SUITE 140
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-3900
Practice Address - Country:US
Practice Address - Phone:303-394-2152
Practice Address - Fax:303-394-2496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO73100374Medicaid
CO73100374Medicaid